Healthcare Provider Details

I. General information

NPI: 1265205280
Provider Name (Legal Business Name): MELANIE ANN JUDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT. 52 STONE COAL RD. HOUSE 192
CRUM WV
25669
US

IV. Provider business mailing address

RT. 52 STONE COAL RD. HOUSE 192
CRUM WV
25669
US

V. Phone/Fax

Practice location:
  • Phone: 304-733-1094
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: