MEDICARE: DR. MELISSA LOUELLEN FORESTER KNUCKLES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	22360	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821074360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA LOUELLEN FORESTER KNUCKLES M.D.

Provider Business Mailing Address
First Line	:	1101 MASTER ST
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701-3511
Country	:	US
Telephone Number	:	606-528-2881
Fax Number	:	696-528-0293

Provider Business Practice Location Address
First Line	:	1101 EAST MASTER STREET
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701-3511
Country	:	US
Telephone Number	:	606-528-2881
Fax Number	:	696-528-0293

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	05/05/2020

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