Provider Demographics
NPI:1619757812
Name:MELTON, FAITH ALEXANDRIA (PA-C)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:ALEXANDRIA
Last Name:MELTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MCNEIL ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3345
Mailing Address - Country:US
Mailing Address - Phone:501-315-1222
Mailing Address - Fax:
Practice Address - Street 1:105 MCNEIL ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3345
Practice Address - Country:US
Practice Address - Phone:501-315-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical