Healthcare Provider Details

I. General information

NPI: 1346817152
Provider Name (Legal Business Name): MELANIE N LAWSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 W MAIN ST
BRODHEAD KY
40409-8893
US

IV. Provider business mailing address

305 PATTERSON BRANCH RD
SOMERSET KY
42503-4745
US

V. Phone/Fax

Practice location:
  • Phone: 606-758-8711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3016240
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: