Provider Demographics
NPI:1447834916
Name:CUNNINGHAM-INGRAM, MELISSA LYNN (LPN)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:LYNN
Last Name:CUNNINGHAM-INGRAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LYNN
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:1255 BELL RUN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1467
Mailing Address - Country:US
Mailing Address - Phone:304-695-4901
Mailing Address - Fax:
Practice Address - Street 1:1255 BELL RUN RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1467
Practice Address - Country:US
Practice Address - Phone:304-695-4901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28733164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV28733OtherWV LPN BOARD