Provider Demographics
NPI:1225355738
Name:SCHELLENBERGER, MELISSA O (APRN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:O
Last Name:SCHELLENBERGER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-272-5063
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:601 S FLOYD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1837
Practice Address - Country:US
Practice Address - Phone:502-588-3650
Practice Address - Fax:502-588-7852
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3006957363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100188220Medicaid
KY7100188220Medicaid