1578749222 NPI number — DR. MELISSA ANN LEVERETTE D.C.

Table of content: DR. MELISSA ANN LEVERETTE D.C. (NPI 1578749222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578749222 NPI number — DR. MELISSA ANN LEVERETTE D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVERETTE
Provider First Name:
MELISSA
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOLLING
Provider Other First Name:
MELISSA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578749222
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
811 LEESBURG PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40324-9766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-263-2774
Provider Business Mailing Address Fax Number:
859-263-2787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1890 STAR SHOOT PKWY STE 185
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40509-4567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-263-2774
Provider Business Practice Location Address Fax Number:
859-263-2787
Provider Enumeration Date:
01/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5152 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100240790 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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