Provider Demographics
NPI:1275504706
Name:FITCH, MELISSA GAIL (CRNA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:GAIL
Last Name:FITCH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 TIFFANY AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1800
Mailing Address - Country:US
Mailing Address - Phone:270-977-0315
Mailing Address - Fax:
Practice Address - Street 1:1020 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:KY
Practice Address - Zip Code:42320-1553
Practice Address - Country:US
Practice Address - Phone:270-274-0480
Practice Address - Fax:270-274-0482
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28172239A367500000X
KY3004125367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000309913OtherANTHEM BCBS PIN
KY74007428Medicaid
KYQ01748Medicare UPIN