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General NPI Number Information
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NPI Number | 1700928140
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Entity Type | Organization
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Legal Business Name | MELISSA L F KNUCKLES MD PSC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1101 EAST MASTER STREET
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City | CORBIN
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State | KY
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Zip | 40701-3511
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Country | US
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Telephone | 606-528-2881
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 MASTER ST
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City | CORBIN
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State | KY
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Zip | 40701-3511
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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 | PRESIDENT
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Name | DR. MELISSA L KNUCKLES
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Credential | M.D.
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Telephone | 606-528-2881
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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 | 22360
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License Number State | KY
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