Provider Demographics
NPI:1023059359
Name:KNOTTS, MELINDA M (APRN-CRNA)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:M
Last Name:KNOTTS
Suffix:
Gender:F
Credentials:APRN-CRNA
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:M
Other - Last Name:HUMPHREYS-KNOTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CRNA
Mailing Address - Street 1:3200 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1227
Mailing Address - Country:US
Mailing Address - Phone:304-388-5503
Mailing Address - Fax:
Practice Address - Street 1:3200 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1227
Practice Address - Country:US
Practice Address - Phone:304-388-5503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN34088-CRNA367500000X
OHCOA.16832-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001718545OtherBCBS
OHP01591881OtherMEDICARE RAILROAD - MHCPI
WV0067309000Medicaid
OH0147421Medicaid
WV001718545OtherBCBS