Provider Demographics
NPI:1184875288
Name:MELTON, CEDALIAH (ARNP)
Entity type:Individual
Prefix:
First Name:CEDALIAH
Middle Name:
Last Name:MELTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6337
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-0337
Mailing Address - Country:US
Mailing Address - Phone:502-895-2334
Mailing Address - Fax:502-896-6987
Practice Address - Street 1:920 DUPONT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4692
Practice Address - Country:US
Practice Address - Phone:502-895-2334
Practice Address - Fax:502-896-6987
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5458P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily