Healthcare Provider Details

I. General information

NPI: 1619974565
Provider Name (Legal Business Name): MELINDA M HENDRICKS-JONES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINDA M HENDRICKS PA

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 11/03/2023
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 W CENTRAL AVE STE 101
TOLEDO OH
43606-3819
US

IV. Provider business mailing address

1 SEAGATE STE 800
TOLEDO OH
43604-1558
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-3900
  • Fax: 419-479-6055
Mailing address:
  • Phone: 567-585-1992
  • Fax: 419-824-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50001552
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50001552
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: