Individual
MELISSA D PACKWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3940 DUPONT CIR, LOUISVILLE, KY 40207-4806
(502) 895-1111
(502) 895-1085
Mailing address
2700 STANLEY GAULT PKWY, SUITE 129, LOUISVILLE, KY 40223-5132
(502) 253-4917
(502) 489-5751
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA760
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0701078
UNITED HEALTHCARE
KY
01
—
50001576
PASSPORT
KY
01
—
600673930W
HUMANA
KY
05
—
95003711
—
KY
01
—
P00466690
RR MEDICARE
KY
Enumeration date
06/21/2005
Last updated
12/07/2020
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