Provider Demographics
NPI:1174851844
Name:MELTON, ASHLEY KATE (CPNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:KATE
Last Name:MELTON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SECURITY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3626
Mailing Address - Country:US
Mailing Address - Phone:731-664-9040
Mailing Address - Fax:
Practice Address - Street 1:10777 HIGHWAY 412 W
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-6283
Practice Address - Country:US
Practice Address - Phone:731-968-5558
Practice Address - Fax:731-968-5567
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014470363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1521474Medicaid