Healthcare Provider Details

I. General information

NPI: 1104512698
Provider Name (Legal Business Name): MELODY ANNE KIMMEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 CAPTAIN DAVIS DR
CAMDEN DE
19934-1748
US

IV. Provider business mailing address

322 CAPTAIN DAVIS DR
CAMDEN DE
19934-1748
US

V. Phone/Fax

Practice location:
  • Phone: 302-598-8914
  • Fax:
Mailing address:
  • Phone: 302-598-8914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberL1-0040104
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: