Provider Demographics
NPI:1033878350
Name:SHIREY, MELINDA KAYE
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:KAYE
Last Name:SHIREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S VALLEY ST APT B9
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-4072
Mailing Address - Country:US
Mailing Address - Phone:769-274-5581
Mailing Address - Fax:
Practice Address - Street 1:610 OLD CANTON RD APT A100
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-4091
Practice Address - Country:US
Practice Address - Phone:769-274-5581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty