Healthcare Provider Details

I. General information

NPI: 1508486267
Provider Name (Legal Business Name): CARA LOUISE MELVIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 09/29/2026
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 W SYCAMORE ST
KOKOMO IN
46901-5148
US

IV. Provider business mailing address

1907 W SYCAMORE ST
KOKOMO IN
46901-5148
US

V. Phone/Fax

Practice location:
  • Phone: 765-456-5687
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71010219A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number28181248A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: