Provider Demographics
NPI:1164044533
Name:WESTFALL, MELISSA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:WESTFALL
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 1:440 GREENUP RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KY
Mailing Address - Zip Code:41169-1087
Mailing Address - Country:US
Mailing Address - Phone:606-694-9065
Mailing Address - Fax:
Practice Address - Street 1:440 GREENUP RD
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KY
Practice Address - Zip Code:41169-1087
Practice Address - Country:US
Practice Address - Phone:606-694-9065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1147805163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management