Provider Demographics
NPI:1700538469
Name:WHITT, MELVINA
Entity Type:Individual
Prefix:
First Name:MELVINA
Middle Name:
Last Name:WHITT
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 1:370 MILDRED AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SHORE
Mailing Address - State:KY
Mailing Address - Zip Code:41175-6901
Mailing Address - Country:US
Mailing Address - Phone:740-464-7109
Mailing Address - Fax:
Practice Address - Street 1:759 CARVER RIDGE RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-1114
Practice Address - Country:US
Practice Address - Phone:740-456-8260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide