Provider Demographics
NPI:1558567230
Name:MELTON, KELLY MAUREEN (ATC, LAT)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:MAUREEN
Last Name:MELTON
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MILLSAPS COLLEGE
Mailing Address - Street 2:1701 N. STATE STREET
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39210-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MILLSAPS COLLEGE
Practice Address - Street 2:1701 N. STATE STREET
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39210-0001
Practice Address - Country:US
Practice Address - Phone:601-974-1378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT03342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer