Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3006932 | KY |
N | 363LP2300X | Nurse Practitioner - Primary Care | 3006932 | KY |
NPI | 1053605774 |
---|---|
Provider Name | Melody A Presley |
First Address | Taylorsville, KY 40071-8616 |
Second Address | Taylorsville, KY 40071-8616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2011 |
Last Update Date | 20/06/2016 |