Provider Demographics
NPI:1366451916
Name:MELTON, KAREN RENEE (AUD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:RENEE
Last Name:MELTON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:RENEE
Other - Last Name:LAMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:620 WALTON DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1935
Mailing Address - Country:US
Mailing Address - Phone:573-756-0500
Mailing Address - Fax:573-756-0505
Practice Address - Street 1:620 WALTON DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1981
Practice Address - Country:US
Practice Address - Phone:573-756-0500
Practice Address - Fax:573-756-0505
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113484231H00000X
MO001230237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200216286 63640 0000OtherTRI-CARE
MO200216286AUDOtherMERCY
MO621859OtherHEALTHLINK
MO7035519OtherAETNA
MO338885437Medicaid
MO20-0216286OtherGM
MO45-00144OtherUHC
MO193973OtherBCBS
MO621859OtherHEALTHLINK