Provider Demographics
NPI: | 1760544928 |
---|---|
Name: | PAFFORD, MELENEY A (APRN) |
Entity Type: | Individual |
Prefix: | |
First Name: | MELENEY |
Middle Name: | A |
Last Name: | PAFFORD |
Suffix: | |
Gender: | F |
Credentials: | APRN |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1000 BRECKENRIDGE ST |
Mailing Address - Street 2: | SUITE 303 |
Mailing Address - City: | OWENSBORO |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 42303-0839 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 270-691-5900 |
Mailing Address - Fax: | 270-852-4924 |
Practice Address - Street 1: | 1000 BRECKENRIDGE ST |
Practice Address - Street 2: | SUITE 303 |
Practice Address - City: | OWENSBORO |
Practice Address - State: | KY |
Practice Address - Zip Code: | 42303-0839 |
Practice Address - Country: | US |
Practice Address - Phone: | 270-691-5900 |
Practice Address - Fax: | 270-852-4924 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-12-14 |
Last Update Date: | 2011-01-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 12404 | 363LP0808X |
KY | 3005526 | 363LP0808X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 7100046300 | Medicaid | |
IN | 200939370 | Medicaid | |
Q77587 | Medicare UPIN | ||
KY | 7100046300 | Medicaid |