Provider Demographics
NPI:1477592293
Name:CUNDIFF-ADAMS, MELONY KAY (NP)
Entity type:Individual
Prefix:MS
First Name:MELONY
Middle Name:KAY
Last Name:CUNDIFF-ADAMS
Suffix:
Gender:F
Credentials:NP
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 340
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42702-0340
Mailing Address - Country:US
Mailing Address - Phone:270-506-2730
Mailing Address - Fax:270-900-0704
Practice Address - Street 1:522 N HOSKINS AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-2117
Practice Address - Country:US
Practice Address - Phone:270-849-2379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4634P363LF0000X
KY3004634363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0948905Medicare ID - Type Unspecified
KYQ52746Medicare UPIN