Healthcare Provider Details

I. General information

NPI: 1093638421
Provider Name (Legal Business Name): MELANIE GORMAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 STRAIGHT ST
GRANT TOWN WV
26574
US

IV. Provider business mailing address

PO BOX 316
GRANT TOWN WV
26574-0316
US

V. Phone/Fax

Practice location:
  • Phone: 304-612-4245
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: