Healthcare Provider Details

I. General information

NPI: 1205744141
Provider Name (Legal Business Name): MELODY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 BALL PARK RD
HARLAN KY
40831-1701
US

IV. Provider business mailing address

PO BOX 99
CUMBERLAND KY
40823-0099
US

V. Phone/Fax

Practice location:
  • Phone: 606-573-4520
  • Fax:
Mailing address:
  • Phone: 606-505-6236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1179314
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: