Provider Demographics
NPI:1235773953
Name:STANISHIA, MELANIE LORENE (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:LORENE
Last Name:STANISHIA
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 FAIRBAIRN CT
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-2656
Mailing Address - Country:US
Mailing Address - Phone:270-903-8445
Mailing Address - Fax:
Practice Address - Street 1:4409 FAIRBAIRN CT
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-2656
Practice Address - Country:US
Practice Address - Phone:270-903-8445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014026363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health