Healthcare Provider Details

I. General information

NPI: 1013902014
Provider Name (Legal Business Name): MELODY QUESENBERRY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1158 LEXINGTON RD
GEORGETOWN KY
40324-9330
US

IV. Provider business mailing address

1158 LEXINGTON RD
GEORGETOWN KY
40324-9330
US

V. Phone/Fax

Practice location:
  • Phone: 502-868-0338
  • Fax: 502-868-0438
Mailing address:
  • Phone: 502-868-0338
  • Fax: 502-868-0438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number3331M
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number3331M
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: