Provider Demographics
NPI:1265849699
Name:WAFFORD, MELISSA KAYE (APRN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAYE
Last Name:WAFFORD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KAYE
Other - Last Name:SLAYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:6425 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2101
Mailing Address - Country:US
Mailing Address - Phone:859-282-0431
Mailing Address - Fax:859-282-1482
Practice Address - Street 1:6425 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2101
Practice Address - Country:US
Practice Address - Phone:859-282-0431
Practice Address - Fax:859-282-1482
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009955363L00000X
OHCOA.16268-NP363LA2200X
OHRN-306449-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100436560Medicaid
KY7100436560Medicaid