Provider Demographics
NPI:1528221173
Name:SKEEN, MELANIE LYNN (DO)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:LYNN
Last Name:SKEEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 HORNER DR
Mailing Address - Street 2:
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219-8107
Mailing Address - Country:US
Mailing Address - Phone:276-298-6869
Mailing Address - Fax:
Practice Address - Street 1:125 HORNER DR
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-8107
Practice Address - Country:US
Practice Address - Phone:276-298-6869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV V2320AMedicare UPIN
VAV V2320BMedicare PIN