Healthcare Provider Details

I. General information

NPI: 1265849699
Provider Name (Legal Business Name): MELISSA KAYE WAFFORD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA KAYE SLAYMAN APRN

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6425 DIXIE HWY
FLORENCE KY
41042-2101
US

IV. Provider business mailing address

6425 DIXIE HWY
FLORENCE KY
41042-2101
US

V. Phone/Fax

Practice location:
  • Phone: 859-282-0431
  • Fax: 859-282-1482
Mailing address:
  • Phone: 859-282-0431
  • Fax: 859-282-1482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3009955
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA.16268-NP
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-306449-1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: