Provider Demographics
NPI:1447810635
Name:MELANIE DRURY APRN LLC
Entity type:Organization
Organization Name:MELANIE DRURY APRN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRURY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:502-428-9573
Mailing Address - Street 1:PO BOX 37170
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-1213
Mailing Address - Country:US
Mailing Address - Phone:888-488-8289
Mailing Address - Fax:833-449-5150
Practice Address - Street 1:10203 WOOD VIOLET CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40228-1944
Practice Address - Country:US
Practice Address - Phone:502-428-9573
Practice Address - Fax:833-449-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100609160Medicaid
KYCS1936500271OtherCARESOURCE
KYPDZ000000910763OtherAETNA BETTER HEALTH