Provider Demographics
NPI:1245974419
Name:WEBSTER, MELISSA GRACE (APRN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GRACE
Last Name:WEBSTER
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 1:103 IOWA CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2971
Mailing Address - Country:US
Mailing Address - Phone:270-401-9984
Mailing Address - Fax:
Practice Address - Street 1:1679 N WILSON RD STE 110
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-1569
Practice Address - Country:US
Practice Address - Phone:270-272-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017677363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100814000Medicaid