Provider Demographics
NPI:1982844379
Name:KING, MELINDA NICOLE (LPN CLC, CD, CIMI)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:NICOLE
Last Name:KING
Suffix:
Gender:F
Credentials:LPN CLC, CD, CIMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 SQUIRE HILL CT
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-3368
Mailing Address - Country:US
Mailing Address - Phone:804-972-8877
Mailing Address - Fax:
Practice Address - Street 1:6504 WOODLAKE VILLAGE CT APT H
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2212
Practice Address - Country:US
Practice Address - Phone:804-972-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002073333164W00000X
171M00000X, 172V00000X, 174H00000X, 174N00000X, 175T00000X, 372500000X, 373H00000X, 376J00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No175T00000XOther Service ProvidersPeer Specialist
No372500000XNursing Service Related ProvidersChore Provider
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No376J00000XNursing Service Related ProvidersHomemaker