Provider Demographics
NPI:1285045047
Name:MELTON, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:MELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 OLD BURR RD
Mailing Address - Street 2:
Mailing Address - City:WARM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72478-9077
Mailing Address - Country:US
Mailing Address - Phone:870-647-1400
Mailing Address - Fax:870-647-2337
Practice Address - Street 1:1033 OLD BURR RD
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72478-9077
Practice Address - Country:US
Practice Address - Phone:870-647-1400
Practice Address - Fax:870-647-2337
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR171M00000XOther17100000X