Provider Demographics
NPI:1447320577
Name:MELTON, PAULA (ARNP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:MELTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 7448
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-7448
Mailing Address - Country:US
Mailing Address - Phone:270-334-3131
Mailing Address - Fax:270-331-3173
Practice Address - Street 1:120 N 4TH ST
Practice Address - Street 2:
Practice Address - City:BARLOW
Practice Address - State:KY
Practice Address - Zip Code:42024-9579
Practice Address - Country:US
Practice Address - Phone:270-334-3131
Practice Address - Fax:270-334-3173
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003517363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78007390Medicaid
KY78007390Medicaid
0257920Medicare ID - Type Unspecified