Healthcare Provider Details

I. General information

NPI: 1790068047
Provider Name (Legal Business Name): MELISSA ANN VINCENT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 W HIGHWAY 146
LA GRANGE KY
40031-9123
US

IV. Provider business mailing address

3001 W HIGHWAY 146
LA GRANGE KY
40031-9123
US

V. Phone/Fax

Practice location:
  • Phone: 502-222-9441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3007036
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: