Individual
RETHA MARCELEEN MELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1155 W. PARKVIEW ST, SUITE 2D, BOLIVAR, MO 65613
(417) 777-2663
(417) 777-2666
Mailing address
1155 W. PARKVIEW ST., SUITE 2D, BOLIVAR, MO 65613
(417) 733-0262
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2020005350
MO
Other
Enumeration date
02/12/2020
Last updated
03/29/2021
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