Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2004006936 | MO |
NPI | 1003867243 |
---|---|
Provider Name | Dr. Kayla S Melton |
First Address | Poplar Bluff, MO 63901-3318 |
Second Address | Poplar Bluff, MO 63901-3318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 06/10/2019 |