Provider Demographics
NPI:1538140694
Name:COATS, MELISSA REGINA (FNP-BC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:REGINA
Last Name:COATS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 WILKINSON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5521
Mailing Address - Country:US
Mailing Address - Phone:980-202-6526
Mailing Address - Fax:855-242-6904
Practice Address - Street 1:4000 WILKINSON BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5521
Practice Address - Country:US
Practice Address - Phone:980-202-6526
Practice Address - Fax:855-242-6904
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201437261QP2300X, 363L00000X
NC109377363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1538140694Medicaid
NC1476EOtherBCBS
NC7005265Medicaid
NCNCL382AMedicare PIN
P25763Medicare UPIN
NC1538140694Medicaid