Provider Demographics
NPI:1093861064
Name:POYNTER, MELISSA JILL (ARNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JILL
Last Name:POYNTER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:859-278-2334
Mailing Address - Fax:859-278-0159
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:B275
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-278-2334
Practice Address - Fax:859-278-0159
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003241363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7800761400Medicaid