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General NPI Number Information
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NPI Number | 1518963073
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Entity Type | Individual
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Provider Name | MELISSA D PACKWOOD PA
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Gender | Female
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 12/07/2020
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Provider Practice Location Address
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Address Line | 3940 DUPONT CIR
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City | LOUISVILLE
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State | KY
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Zip | 40207-4806
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Country | US
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Telephone | 502-895-1111
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Fax | 502-895-1085
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Provider Business Mailing Address
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Address Line | 2700 STANLEY GAULT PKWY SUITE 129
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City | LOUISVILLE
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State | KY
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Zip | 40223-5132
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Country | US
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Telephone | 502-253-4917
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Fax | 502-489-5751
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA760
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License Number State | KY
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