Provider Demographics
NPI:1770695538
Name:HANN, MELINDA E (ARNP)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:E
Last Name:HANN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 LINDSAY LN
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-9621
Mailing Address - Country:US
Mailing Address - Phone:270-726-4455
Mailing Address - Fax:
Practice Address - Street 1:1719 NASHVILLE ST
Practice Address - Street 2:SUITE C
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-8855
Practice Address - Country:US
Practice Address - Phone:270-726-7664
Practice Address - Fax:270-726-9997
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2574363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0511704Medicare ID - Type Unspecified
KYP15772Medicare UPIN