Provider Demographics
NPI:1114379997
Name:MELTON, KARSON TAYLOR
Entity Type:Individual
Prefix:
First Name:KARSON
Middle Name:TAYLOR
Last Name:MELTON
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 1:179 COUNTY ROAD 61
Mailing Address - Street 2:
Mailing Address - City:RICEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37370-5451
Mailing Address - Country:US
Mailing Address - Phone:423-368-0232
Mailing Address - Fax:
Practice Address - Street 1:179 COUNTY ROAD 61
Practice Address - Street 2:
Practice Address - City:RICEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37370-5451
Practice Address - Country:US
Practice Address - Phone:423-368-0232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2737314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility