Individual
ANDREA R MELVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
2601 KENTUCKY AVE, STE 301, PADUCAH, KY 42003-3817
(270) 575-3113
(270) 575-3135
Mailing address
PO BOX 7648, PADUCAH, KY 42002-7648
(270) 575-3113
(270) 575-3135
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA802
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000512695
ANTHEM
—
01
—
862893
HEALTHLINK
—
05
—
9500390100
—
KY
Enumeration date
11/16/2005
Last updated
03/25/2008
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