Provider Demographics
NPI:1164634630
Name:MELBA, KAY MOTZ (APRN)
Entity Type:Individual
Prefix:MS
First Name:KAY
Middle Name:MOTZ
Last Name:MELBA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 S SWEETWATER HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:SC
Mailing Address - Zip Code:29369
Mailing Address - Country:US
Mailing Address - Phone:864-486-8106
Mailing Address - Fax:
Practice Address - Street 1:10701 ANDERSON RD
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642
Practice Address - Country:US
Practice Address - Phone:864-295-2500
Practice Address - Fax:864-295-2506
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0119Medicaid
SCMM0295495OtherDEA REGISTRATION #
SCNP0119Medicaid