Provider Demographics
NPI:1770144362
Name:CUNNINGHAM, MELONY JOY
Entity type:Individual
Prefix:
First Name:MELONY
Middle Name:JOY
Last Name:CUNNINGHAM
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 1:4101 TATES CREEK CENTRE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3096
Mailing Address - Country:US
Mailing Address - Phone:859-797-7849
Mailing Address - Fax:
Practice Address - Street 1:4229 RIDGEWATER DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-6010
Practice Address - Country:US
Practice Address - Phone:859-797-7849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty