Provider Demographics
NPI:1952060691
Name:WERNER, MELISSA SUE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:WERNER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164-1159
Mailing Address - Country:US
Mailing Address - Phone:775-287-7638
Mailing Address - Fax:
Practice Address - Street 1:1048 ASHLEY ST STE 201
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-2449
Practice Address - Country:US
Practice Address - Phone:270-205-4585
Practice Address - Fax:270-847-0024
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017118363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3017118OtherKBN