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General NPI Number Information
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NPI Number | 1124871124
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Entity Type | Individual
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Provider Name | LAURETTA KAYLOR-MELANEY PMD
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Gender | Female
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Dates
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Enumeration Date | 04/09/2024
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 740 GREELAND AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32221-4404
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Country | US
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Telephone | 407-663-7729
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Fax |
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Provider Business Mailing Address
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Address Line | 156 BIRD OF PARADISE DR
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City | PALM COAST
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State | FL
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Zip | 32137-9312
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number | EMT556102
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 146L00000X
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Taxonomy Name | Paramedic
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License Number | PMD535758
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License Number State | FL
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