Provider Demographics
NPI:1932209640
Name:MCKAY, MELANIE LEE (CNM)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:LEE
Last Name:MCKAY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MRS
Other - First Name:MELANIE
Other - Middle Name:MITCHELL
Other - Last Name:KOHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:5615 NE 32ND PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6841
Mailing Address - Country:US
Mailing Address - Phone:503-331-1853
Mailing Address - Fax:
Practice Address - Street 1:12607 SE MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6055
Practice Address - Country:US
Practice Address - Phone:360-418-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA AP30002048367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife