Healthcare Provider Details

I. General information

NPI: 1366451916
Provider Name (Legal Business Name): KAREN RENEE MELTON AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN RENEE LAMB AU.D.

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 WALTON DR
FARMINGTON MO
63640-1981
US

IV. Provider business mailing address

620 WALTON DR
FARMINGTON MO
63640-1935
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-0500
  • Fax: 573-756-0505
Mailing address:
  • Phone: 573-756-0500
  • Fax: 573-756-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number113484
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number001230
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: