Provider Demographics
NPI:1437578077
Name:BENTLEY, MELISSA (FNP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:FENLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3425 ASHTON DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3317
Mailing Address - Country:US
Mailing Address - Phone:770-713-4150
Mailing Address - Fax:
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7694
Practice Address - Country:US
Practice Address - Phone:678-312-3317
Practice Address - Fax:678-312-4416
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN203453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily