Provider Demographics
NPI:1407314461
Name:RATH, MELINDA D (NP-C)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:D
Last Name:RATH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:DIANE
Other - Last Name:SIDLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2807 KY HIGHWAY 36 W
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-7341
Mailing Address - Country:US
Mailing Address - Phone:859-421-7917
Mailing Address - Fax:
Practice Address - Street 1:2807 KY HIGHWAY 36 W
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-7341
Practice Address - Country:US
Practice Address - Phone:859-421-7917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily