MEDICARE: MRS. MELISSA KAY PUCKETT RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	332020	OH

General Provider Information

NPI Number	:	1619939790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA KAY PUCKETT RN

Provider Business Mailing Address
First Line	:	14558 WALNUT CREEK PIKE
Second Line	:
City	:	ASHVILLE
State	:	OH
Zip	:	43103-9351
Country	:	US
Telephone Number	:	740-983-2902
Fax Number	:

Provider Business Practice Location Address
First Line	:	14558 WALNUT CREEK PIKE
Second Line	:
City	:	ASHVILLE
State	:	OH
Zip	:	43103-9351
Country	:	US
Telephone Number	:	740-983-2902
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	07/08/2007

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