Provider Demographics
NPI:1417239625
Name:MELLENDICK, KATIE MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:MARIE
Last Name:MELLENDICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5755 CEDAR LN
Mailing Address - Street 2:SUITE 134
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2912
Mailing Address - Country:US
Mailing Address - Phone:410-740-7777
Mailing Address - Fax:410-884-4749
Practice Address - Street 1:5755 CEDAR LN
Practice Address - Street 2:SUITE 134
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2912
Practice Address - Country:US
Practice Address - Phone:410-740-7777
Practice Address - Fax:410-884-4749
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical