Provider Demographics
NPI:1568595619
Name:MELTON, STELLA M (LPN)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:M
Last Name:MELTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:STELLA
Other - Middle Name:K
Other - Last Name:MELTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPRP CERTIFIED PSYCH
Mailing Address - Street 1:DEPARTMENT 888182
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37995-8182
Mailing Address - Country:US
Mailing Address - Phone:800-355-3565
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:215 HEDRICK DRIVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821
Practice Address - Country:US
Practice Address - Phone:423-623-5301
Practice Address - Fax:423-625-0808
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN2300164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse