Provider Demographics
NPI:1275892473
Name:RICHARDS, MELINDA KAY (APRN)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:KAY
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:MELINDA
Other - Middle Name:KAY
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2877
Practice Address - Country:US
Practice Address - Phone:502-852-5689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007430363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201114150Medicaid
KY50043898OtherPASSPORT
KY000000794625OtherANTHEM BC/BS
KY7100217570Medicaid
IN201114150Medicaid