Provider Demographics
NPI:1376768671
Name:ELLSWORTH--MELTON, ANDREA LEIGH (MAE)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LEIGH
Last Name:ELLSWORTH--MELTON
Suffix:
Gender:F
Credentials:MAE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 HIGGS LN
Mailing Address - Street 2:
Mailing Address - City:RUMSEY
Mailing Address - State:KY
Mailing Address - Zip Code:42371-9605
Mailing Address - Country:US
Mailing Address - Phone:270-273-3085
Mailing Address - Fax:270-273-5924
Practice Address - Street 1:477 HIGGS LN
Practice Address - Street 2:
Practice Address - City:RUMSEY
Practice Address - State:KY
Practice Address - Zip Code:42371-9605
Practice Address - Country:US
Practice Address - Phone:270-273-3085
Practice Address - Fax:270-273-5924
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist