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General NPI Number Information
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NPI Number | 1295727592
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Entity Type | Individual
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Provider Name | MELYNDA MATHERLY P.A. C.
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Gender | Female
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 02/06/2020
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Provider Practice Location Address
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Address Line | 111 DANIEL DR
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City | DANVILLE
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State | KY
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Zip | 40422-2527
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Country | US
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Telephone | 859-236-0916
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Fax | 859-236-0917
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Provider Business Mailing Address
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Address Line | PO BOX 6
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City | DANVILLE
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State | KY
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Zip | 40423-0006
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Country | US
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Telephone | 859-236-0916
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Fax | 859-236-0917
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA591
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License Number State | KY
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