Provider Demographics
NPI:1083040729
Name:MELTON, AMBER B (RN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:B
Last Name:MELTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MEADOW LANE
Mailing Address - Street 2:
Mailing Address - City:HOWE
Mailing Address - State:OK
Mailing Address - Zip Code:74940-0000
Mailing Address - Country:US
Mailing Address - Phone:918-658-2509
Mailing Address - Fax:918-658-2180
Practice Address - Street 1:1000 MEADOW LANE
Practice Address - Street 2:
Practice Address - City:HOWE
Practice Address - State:OK
Practice Address - Zip Code:74940-0000
Practice Address - Country:US
Practice Address - Phone:918-658-2509
Practice Address - Fax:918-658-2180
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376K00000X
OK111516163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide