Provider Demographics
NPI:1740343896
Name:FLETCHER, MELISSA CAROL (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:CAROL
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:INEZ
Mailing Address - State:KY
Mailing Address - Zip Code:41224-8931
Mailing Address - Country:US
Mailing Address - Phone:606-298-2660
Mailing Address - Fax:606-298-2660
Practice Address - Street 1:202 BEVINS LN
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-6178
Practice Address - Country:US
Practice Address - Phone:859-323-9333
Practice Address - Fax:502-570-5063
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000230164OtherBLUE CROSS AND BLUE SHIEL
KY64020159Medicaid
1199425OtherCHA
KY000000230164OtherBLUE CROSS AND BLUE SHIEL
0730602Medicare ID - Type Unspecified