Provider Demographics
NPI:1255641312
Name:LOFTON-BERRY, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LOFTON-BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W. MUHAMMAD ALI BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1451
Mailing Address - Country:US
Mailing Address - Phone:502-589-6000
Mailing Address - Fax:502-589-8771
Practice Address - Street 1:600 S. PRESTON ST.
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1451
Practice Address - Country:US
Practice Address - Phone:502-589-6000
Practice Address - Fax:502-589-8771
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2031370164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse