Individual ProviderMelissandre HenryNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address125 Queens Rd Ste 610, Charlotte, NC 28204-3580(980) 302-6600PECOS EnrollmentBased on the most recent information from CMS, provider Melissandre Henry is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1609632942Provider TypeIndividualFull NameHenry, MelissandreCredentialFNPGenderFemaleSole ProprietorNoEnumeration Date2/23/2024Last Updated10/17/2025Contact InformationPractice LocationPractice Address125 Queens Rd Ste 610, Charlotte, NC 28204-3580Phone(980) 302-6600Fax(980) 302-6605Mailing LocationMailing AddressPO Box 60447, Charlotte, NC 28260-0447Phone(980) 302-6600Fax(980) 302-6605Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense5020080North CarolinaCode363L00000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense5020080North CarolinaCode363LF0000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense1156726TexasCode363LF0000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseAPRN11031477Florida