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Individual

KENNETH MELTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ANP

Contact information

Practice address
253 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906-1501
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28190142A
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
71005004A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000888197
ANTHEM PROVIDER NUMBER
IN
05
201242480
IN
Enumeration date
03/11/2014
Last updated
02/23/2015
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