Provider Demographics
NPI:1932425766
Name:CHILDRESS, MELINDA GAYLOR (MED, RRT, AE-C)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:GAYLOR
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:MED, RRT, AE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6008 JOHN MOSER WAY
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8530
Mailing Address - Country:US
Mailing Address - Phone:502-339-5699
Mailing Address - Fax:502-638-3801
Practice Address - Street 1:6008 JOHN MOSER WAY
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-8530
Practice Address - Country:US
Practice Address - Phone:502-339-5699
Practice Address - Fax:502-638-3801
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12962278G1100X
IN30002755A2279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care
No2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care