Provider Demographics
NPI: | 1306000666 |
---|---|
Name: | TRAVELSTED, MELISSA K (ARNP) |
Entity Type: | Individual |
Prefix: | |
First Name: | MELISSA |
Middle Name: | K |
Last Name: | TRAVELSTED |
Suffix: | |
Gender: | F |
Credentials: | ARNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 9510 ORMSBY STATION RD STE 100 |
Mailing Address - Street 2: | |
Mailing Address - City: | LOUISVILLE |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40223-4082 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 502-327-9100 |
Mailing Address - Fax: | 855-632-8329 |
Practice Address - Street 1: | 9510 ORMSBY STATION RD STE 100 |
Practice Address - Street 2: | |
Practice Address - City: | LOUISVILLE |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40223 |
Practice Address - Country: | US |
Practice Address - Phone: | 502-327-9100 |
Practice Address - Fax: | 855-632-8329 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2008-07-16 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KY | 3005685 | 363LF0000X, 363L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
12429641 | Other | CAQH |