Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 33713 | NC |
NPI | 1003815994 |
---|---|
Provider Name | Kenneth Melton |
First Address | Fayetteville, NC 28304-4433 |
Second Address | Fayetteville, NC 28304-4433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 21/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7958616 | (05) | NC |
E04307 | (02) | NC |