Individual
MS. CONNIE ANN MELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1025 S 2ND ST, LOUISVILLE, KY 40203-2823
(502) 584-2473
(502) 657-0228
Mailing address
PO BOX 87, DUPONT, IN 47231-0087
(812) 273-3737
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA152
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
50006904
—
KY
Enumeration date
06/19/2006
Last updated
07/08/2007
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