Provider Demographics
NPI:1881115269
Name:MCCARTY BILBREY, MELIA ANNE (CNA/HHA)
Entity type:Individual
Prefix:
First Name:MELIA
Middle Name:ANNE
Last Name:MCCARTY BILBREY
Suffix:
Gender:F
Credentials:CNA/HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 W KILGORE AVE TRLR 85
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4776
Mailing Address - Country:US
Mailing Address - Phone:765-499-7315
Mailing Address - Fax:
Practice Address - Street 1:5600 W KILGORE AVE TRLR 85
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4776
Practice Address - Country:US
Practice Address - Phone:765-499-7315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCNA1007492376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN82-2076862Medicaid