Provider Demographics
NPI:1235343286
Name:ELKINS-SMITH, MELINDA L (MD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:L
Last Name:ELKINS-SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-9571
Mailing Address - Fax:
Practice Address - Street 1:2028 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7744
Practice Address - Country:US
Practice Address - Phone:606-326-9001
Practice Address - Fax:606-326-9005
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00669779OtherRR MEDICARE
OH2757897Medicaid
KY7100013380Medicaid
KY000000598122OtherANTHEM BCBS
KY000000525641OtherANTHEM BCBS
OH2757897Medicaid
KY000000598122OtherANTHEM BCBS
KY0631723Medicare PIN
KY0085302Medicare PIN
KY00606002Medicare PIN