Provider Demographics
NPI:1659375590
Name:STATEN, MELINDA L (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:L
Last Name:STATEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-239-9920
Mailing Address - Fax:502-239-9936
Practice Address - Street 1:3924 S DUPONT SQ STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-893-3510
Practice Address - Fax:502-894-9863
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3001777163WU0100X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WU0100XNursing Service ProvidersRegistered NurseUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78000668Medicaid
KY00839002Medicare PIN
KYS47657Medicare UPIN
KY78000668Medicaid