Melissa Diana McKenzie, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

CNP201420 Issued in ME

Practice address

37 Palmer St Ste 1
Calais, ME 04619-1341

Phone

(207) 454-7521

Fax

(207) 454-3616

NPI assigned

Jun 14, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Melissa Diana Morris Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Calais Community Hospital

  • Critical Access Hospital
  • Calais, ME
  • NPI 1922001049
  NPD (past)
• Unifour Pediatrics, PA

  • Pediatrics Physician
  • Conover, NC
  • NPI 1770782450
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1407050164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 WOODLAWN RD",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296469163",
            "telephone_number": "828-244-8380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 PALMER ST STE 1",
            "city": "CALAIS",
            "state": "ME",
            "postal_code": "046191341",
            "telephone_number": "207-454-7521",
            "fax_number": "207-454-3616"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3411 Graystone Pl SE",
            "address_purpose": "LOCATION",
            "city": "Conover",
            "state": "NC",
            "postal_code": "286138200",
            "country_code": "US",
            "telephone_number": "828-328-1118",
            "fax_number": "828-328-1119",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "407 W South St",
            "address_purpose": "LOCATION",
            "city": "Union",
            "state": "SC",
            "postal_code": "293792771",
            "country_code": "US",
            "telephone_number": "864-429-8846",
            "fax_number": "864-429-9093",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "MELISSA",
        "middle_name": "DIANA",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-14",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "SC",
            "license": "3247",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5003497",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "ME",
            "license": "CNP201420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "SCL446H895",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP3680",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmckenzie233176@direct-srhs.et0939.epichosted.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mmckenzie233176@direct-srhs.et0939.epichosted.com",
            "address_1": "407 W South St",
            "city": "Union",
            "state": "SC",
            "country_code": "US",
            "postal_code": "293792771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "MORRIS",
            "middle_name": "DIANA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Magnolia Assisted Living, LLC
• Kevin J Makarowski
• Vicki D. Mason, OQMHP-C-PNMI
• Katherine E Matthews, MS, OTRL
• Dari-Lee McConnell, MHRT-C
• Meredith McLaughlin
• Crystal Lynn McLellan
• Scott Anthony McMichael, LADC
• Tanya J. McNally, OQMHP-C-PNMI
• Jessica Melhiser, OQMHP-C, MHRT-CSP

• Pediatric Nurse Practitioner in Calais, ME
• Providers in Calais, ME by specialty
• Pediatric Nurse Practitioner in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.