Provider Demographics
NPI:1396738035
Name:MELTON, JODIE L (CRNP)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:L
Last Name:MELTON
Suffix:
Gender:F
Credentials:CRNP
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 98
Mailing Address - Street 2:
Mailing Address - City:LINEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36266-0098
Mailing Address - Country:US
Mailing Address - Phone:256-396-2141
Mailing Address - Fax:
Practice Address - Street 1:60026 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:LINEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36266-4735
Practice Address - Country:US
Practice Address - Phone:256-396-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-082713363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner