Provider Demographics
NPI:1619939790
Name:PUCKETT, MELISSA KAY (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:KAY
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14558 WALNUT CREEK PIKE
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43103-9351
Mailing Address - Country:US
Mailing Address - Phone:740-983-2902
Mailing Address - Fax:
Practice Address - Street 1:14558 WALNUT CREEK PIKE
Practice Address - Street 2:
Practice Address - City:ASHVILLE
Practice Address - State:OH
Practice Address - Zip Code:43103-9351
Practice Address - Country:US
Practice Address - Phone:740-983-2902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332020163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse