Melissa Lara, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

001010618 Issued in NC

Practice address

1298 N Main St
Fuquay Varina, NC 27526-2615

Phone

(919) 590-4099

NPI assigned

Oct 14, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1602633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602633600000",
    "number": "1609474303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 E DAVIE ST APT 530",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276013055",
            "telephone_number": "704-737-8410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1298 N MAIN ST",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275262615",
            "telephone_number": "919-590-4099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARA",
        "first_name": "MELISSA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-14",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "001010618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Lane
• Patricia Holyfield Lane, MS, OTR/L
• Claudine Bernice Langdon, LCMHC
• Brandon Langworthy, DPT
• Kristen Labianca Langworthy, DDS
• Stephanie Katherine Lastra, PMHNP
• Laura Yarger DDS PLLC
• Aspyn Lee
• Mi Rim Lee, OD
• Brian Leech, DMD

• Medical Physician Assistant in Fuquay Varina, NC
• Providers in Fuquay Varina, NC by specialty
• Medical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.