Provider Demographics
NPI:1770764789
Name:HARTWELL, MELISSA LYNN (PA-C)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:LYNN
Last Name:HARTWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 CAMPUS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-9700
Mailing Address - Country:US
Mailing Address - Phone:276-739-8010
Mailing Address - Fax:276-625-1410
Practice Address - Street 1:603 CAMPUS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-9700
Practice Address - Country:US
Practice Address - Phone:276-739-8010
Practice Address - Fax:276-625-1410
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002632363AM0700X
TN1625363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1770764789Medicaid
TN1509053Medicaid
VA1770764789Medicaid
TN1509053Medicaid
VAVV4928AMedicare PIN
TN3709285Medicare UPIN