Provider Demographics
NPI:1780747857
Name:MOYNAN-SMITH, MELANIE K (CNP)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:K
Last Name:MOYNAN-SMITH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 PARKS HALL
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:740-593-2516
Mailing Address - Fax:740-593-2905
Practice Address - Street 1:246 PARKS HALL
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:740-593-2516
Practice Address - Fax:740-593-2905
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.05038-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000671228OtherANTHEM
OH305660OtherUNISON
WV3810018096Medicaid
WV10047007OtherBWC
OH6190173OtherCIGNA
OH2110790Medicaid
OH6190173OtherCIGNA
WV3810018096Medicaid