Healthcare Provider Details

I. General information

NPI: 1629431499
Provider Name (Legal Business Name): MELISSA MEFFORD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA KINNE

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 W MAIN ST STE 1
VEVAY IN
47043-9125
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 812-427-0233
  • Fax: 812-427-0303
Mailing address:
  • Phone: 859-344-5555
  • Fax: 859-344-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01082960A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: