Provider Demographics
NPI:1558322669
Name:MATHENY, MELANIE D (FNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:D
Last Name:MATHENY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:809 FARSON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1066
Practice Address - Country:US
Practice Address - Phone:740-401-0033
Practice Address - Fax:740-401-0039
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV33982363LF0000X
OHCOA.14136-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP010152504OtherRAILROAD MEDICARE - MHCPI
WV7103008000Medicaid
OH0077033Medicaid
OHH166321Medicare PIN
P04098Medicare UPIN
WVWV1861A655Medicare UPIN
OHH163320Medicare PIN
OHP010152504OtherRAILROAD MEDICARE - MHCPI
WVWV1861AMedicare PIN
WVNP05592Medicare ID - Type Unspecified