Provider Demographics
NPI:1275425084
Name:KELLEY, MELODY RAE WALLACE (CBD (AWWS))
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:RAE WALLACE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:CBD (AWWS)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 OLD CHARLESTON RD NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-6651
Mailing Address - Country:US
Mailing Address - Phone:423-508-4848
Mailing Address - Fax:
Practice Address - Street 1:248 OLD CHARLESTON RD NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-6651
Practice Address - Country:US
Practice Address - Phone:423-508-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula