Provider Demographics
NPI:1295124766
Name:KENTER, MELISSA K (APN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:KENTER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:K
Other - Last Name:PAHOLKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-0372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2040 LINCOLN AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-3197
Practice Address - Country:US
Practice Address - Phone:217-345-2030
Practice Address - Fax:217-345-2045
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily