Melanie Creppel Bourgeois, FNP
Individual provider Active NPI Family Nurse Practitioner · Kingsport, TN
NPI 1497220214 · NPPES record last updated Oct 8, 2018
Key facts
- NPI
- 1497220214
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- APN000024525 (TN)
- Practice address
- 4606 Sundown Dr
Kingsport, TN 37664-6913 - Phone
- (423) 367-3323
- NPI assigned
- Oct 8, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (5 enrollments) in WV, OH, NC, TN, MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220926000557 | WV | Practitioner - Nurse Practitioner | 6103203617 | Reassigns benefits to 2 organizations |
| I20221108002026 | OH | Practitioner - Nurse Practitioner | 6103203617 | Reassigns benefits to 1 organization |
| I20230119002181 | NC | Practitioner - Nurse Practitioner | 6103203617 | Reassigns benefits to 1 organization |
| I20231227002525 | TN | Practitioner - Nurse Practitioner | 6103203617 | Reassigns benefits to 1 organization |
| I20231228000946 | MS | Practitioner - Nurse Practitioner | 6103203617 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APN000024525 | TN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Matrix Medical Network of West | Current |
Accepting new patients | |
| Matrix Medical Plus | Current |
Accepting new patients |
Locations
9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883
8601 Six Forks Rd
#I
Raleigh, NC 27615
5100 Poplar Ave
Fl 27
Memphis, TN 38137
Phone (205) 538-3076
424 Church St
Ste 2600
Nashville, TN 37219
Phone (480) 450-3721
209 Washington St W
Charleston, WV 25302
Phone 24852821166
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | APN000024525 | TN | Yes |
Addresses
Primary practice location
4606 Sundown Dr
Kingsport, TN 37664-6913
Mailing address
4606 Sundown Dr
Kingsport, TN 37664-6913
Phone (423) 367-3323
Other providers in Kingsport, TN
- Benjamin Borders
- James Hunter Botts
- Devi Prasad Botu
- Amanda Boudreaux
- Renee L Boulicault
- Vickie R Bowen
- Carissa Renee Bowery
- Jacqlyne Weber Bowman
- Traci Bowman
- Abigail L Box
All providers in Kingsport, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.