Provider Demographics
NPI:1578684247
Name:MYERS, MELISSA GAYLE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:GAYLE
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6654 STATEROAD 1668
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:KY
Mailing Address - Zip Code:42064
Mailing Address - Country:US
Mailing Address - Phone:270-965-4516
Mailing Address - Fax:
Practice Address - Street 1:6654 STATE ROAD 1668
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:KY
Practice Address - Zip Code:42064
Practice Address - Country:US
Practice Address - Phone:270-965-4516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator