Healthcare Provider Details

I. General information

NPI: 1821464561
Provider Name (Legal Business Name): MELINDA LYONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINDA MCCOWAN

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S 3RD ST
DANVILLE KY
40422-2016
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-7712
  • Fax: 859-236-7246
Mailing address:
  • Phone: 270-858-6644
  • Fax: 270-858-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number3009473
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: