Provider Demographics
NPI:1831627389
Name:SMALLWOOD, MELISSA HORNSBY (APRN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:HORNSBY
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:230 LEXINGTON GREEN CIR STE 600
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3326
Mailing Address - Country:US
Mailing Address - Phone:859-971-4695
Mailing Address - Fax:859-971-4604
Practice Address - Street 1:2108 NICHOLASVILLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2502
Practice Address - Country:US
Practice Address - Phone:859-278-9413
Practice Address - Fax:859-276-0715
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3011404363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner