Provider Demographics
NPI:1447203724
Name:STORY, MELANIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:A
Last Name:STORY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MELANIE
Other - Middle Name:STORY
Other - Last Name:APPLEGATE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:175 S ENGLISH STATION RD
Mailing Address - Street 2:SUITE 223
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-4160
Mailing Address - Country:US
Mailing Address - Phone:502-890-4242
Mailing Address - Fax:502-890-4245
Practice Address - Street 1:175 S ENGLISH STATION RD
Practice Address - Street 2:SUITE 223
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-4160
Practice Address - Country:US
Practice Address - Phone:502-890-4242
Practice Address - Fax:502-890-4245
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64101785Medicaid
KYP00301262Medicare PIN
KYI20208Medicare UPIN
KY64101785Medicaid