Provider Demographics
NPI:1043440951
Name:JOHNSON, MELISSA LOFTIN (RN, NP-C)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:LOFTIN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN, NP-C
Other - Prefix:
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Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-248-4413
Mailing Address - Fax:336-248-6260
Practice Address - Street 1:106 W MEDICAL PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-6853
Practice Address - Country:US
Practice Address - Phone:336-248-4413
Practice Address - Fax:336-248-6260
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC171010363LF0000X
NC500445363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC700453Medicaid
NCNC9604AMedicare PIN