Healthcare Provider Details

I. General information

NPI: 1124871124
Provider Name (Legal Business Name): LAURETTA KAYLOR-MELANEY PMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 GREELAND AVE
JACKSONVILLE FL
32221-4404
US

IV. Provider business mailing address

156 BIRD OF PARADISE DR
PALM COAST FL
32137-9312
US

V. Phone/Fax

Practice location:
  • Phone: 407-663-7729
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberEMT556102
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberPMD535758
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: