Provider Demographics
NPI:1689710683
Name:MORROW, MELINDA KAY (PA)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:KAY
Last Name:MORROW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6725
Mailing Address - Country:US
Mailing Address - Phone:330-729-4298
Mailing Address - Fax:330-729-1897
Practice Address - Street 1:8423 MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6778
Practice Address - Country:US
Practice Address - Phone:330-729-3190
Practice Address - Fax:330-729-8701
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50003278363A00000X, 363A00000X
VA0110001554363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0100316Medicaid
OH0100316Medicaid
OH0100316Medicaid