Healthcare Provider Details

I. General information

NPI: 1457276248
Provider Name (Legal Business Name): MELINDA DAWN MONKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4923 WOODWARD DR
CHARLESTON WV
25312-6347
US

IV. Provider business mailing address

4923 WOODWARD DR
CHARLESTON WV
25312-6347
US

V. Phone/Fax

Practice location:
  • Phone: 304-807-5393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA3M136900133
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: