1518303957 NPI number — MELISSA K BRANDS APRN-NP

Table of content: MELISSA K BRANDS APRN-NP (NPI 1518303957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518303957 NPI number — MELISSA K BRANDS APRN-NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANDS
Provider First Name:
MELISSA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN-NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518303957
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 21ST AVE N
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-1821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-329-5144
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 ABRAHAM FLEXNER WAY
Provider Second Line Business Practice Location Address:
SUITE 1101
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-3841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-581-1951
Provider Business Practice Location Address Fax Number:
502-540-5137
Provider Enumeration Date:
05/13/2013

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: 363L00000X , with the licence number:  1115234 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 25952 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: 3008051 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 201175500 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100244860 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".