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General NPI Number Information
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NPI Number | 1790940146
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Entity Type | Individual
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Provider Name | MELISSA BLAIR WHITAKER PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/25/2008
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Last Update Date | 05/23/2018
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Provider Practice Location Address
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Address Line | 2616 LEGENDS WAY
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City | CRESTVIEW HILLS
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State | KY
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Zip | 41017
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Country | US
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Telephone | 859-331-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 2616 LEGENDS WAY
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City | CRESTVIEW HILLS
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State | KY
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Zip | 41017-2418
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Country | US
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Telephone | 859-331-3100
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10001781A
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License Number State | IN
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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 | 008619
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1130
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License Number State | KY
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