Provider Demographics
NPI:1073197356
Name:MELTON, MELISSA N (RDN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:N
Last Name:MELTON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 WINCHESTER WAY
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63389-2322
Mailing Address - Country:US
Mailing Address - Phone:636-448-5376
Mailing Address - Fax:
Practice Address - Street 1:395 WINCHESTER WAY
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:MO
Practice Address - Zip Code:63389-2322
Practice Address - Country:US
Practice Address - Phone:636-448-5376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO225700000X
MO86100680133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist