Individual provider Active NPI

Melissa Cork, FNP-C

  • Family Nurse Practitioner
  • Livonia, MI
National Provider Identifier
1639899099
Registry record updated Sep 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704301365 Issued in MI
Practice address
20433 Maplewood St
Livonia, MI 48152-2022
Phone
(248) 812-6647
NPI assigned
Aug 29, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X MI
Family Nurse Practitioner 363LF0000X 4704301365 MI Primary

Addresses

Primary practice location

20433 Maplewood St
Livonia, MI 48152-2022

Mailing address

20433 Maplewood St
Livonia, MI 48152-2022
Phone (248) 812-6647

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221221000633 MI Practitioner - Nurse Practitioner 2961872676 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Complexcare Medical Group Midwest H PLLCGroup PAC ID 0143737148, 128 clinicians
Theoria MedicalGroup PAC ID 5395098339, 317 clinicians

Practice addresses (Care Compare)

34225 Grand River Ave
Farmington, MI 48335-3440
Phone (248) 477-7373

5201 Conner St
Detroit, MI 48213-3405
Phone (313) 571-5555

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Complexcare Medical Group Midwest H PLLC CurrentSince Jun 10, 2025 Accepting new patients
Theoria Medical CurrentSince Dec 16, 2022 Accepting new patients

Locations

5655 Clarkston Rd
Clarkston, MI 48348
Phone (810) 623-5216

5201 Conner St
Detroit, MI 48213
Phone (313) 571-5555

6700 W Outer Dr
Detroit, MI 48235
Phone (313) 836-1700

34225 Grand River Ave
Farmington Hills, MI 48335
Phone (248) 477-7373

3139 E Baldwin Rd
Grand Blanc, MI 48439
Phone (810) 445-5300

331 Meadows Dr
Grayling, MI 49738
Phone (989) 348-2801

41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1661731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1639899099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20433 MAPLEWOOD ST",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481522022",
            "telephone_number": "248-812-6647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20433 MAPLEWOOD ST",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481522022",
            "telephone_number": "248-812-6647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORK",
        "first_name": "MELISSA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-29",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704301365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livonia, MI

Sources for this page

Verify at the official NPI Registry.