Provider Demographics
NPI:1932838232
Name:HENRY, MELISSA PEARL
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:PEARL
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MEG DR APT 2C
Mailing Address - Street 2:
Mailing Address - City:SISSONVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25320-9724
Mailing Address - Country:US
Mailing Address - Phone:304-744-4940
Mailing Address - Fax:
Practice Address - Street 1:2 MEG DR APT 2C
Practice Address - Street 2:
Practice Address - City:SISSONVILLE
Practice Address - State:WV
Practice Address - Zip Code:25320-9724
Practice Address - Country:US
Practice Address - Phone:304-744-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant