Individual
MRS. MELYNDA MATHERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A. C.
Contact information
Practice address
111 DANIEL DR, DANVILLE, KY 40422-2527
(859) 236-0916
(859) 236-0917
Mailing address
PO BOX 6, DANVILLE, KY 40423-0006
(859) 236-0916
(859) 236-0917
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
363A00000X
Physician Assistant
Primary
PA591
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9500395000
—
KY
Enumeration date
08/22/2005
Last updated
02/06/2020
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