=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790068047
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA ANN VINCENT APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2011
-----------------------------------------------------
Last Update Date | 09/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3001 W HIGHWAY 146
-----------------------------------------------------
City | LA GRANGE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40031-9123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-222-9441
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3001 W HIGHWAY 146
-----------------------------------------------------
City | LA GRANGE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40031-9123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 3007036
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------