1215913249 NPI number — MS. MELINDA LEDBETTER APA-C

Table of content: MS. MELINDA LEDBETTER APA-C (NPI 1215913249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215913249 NPI number — MS. MELINDA LEDBETTER APA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEDBETTER
Provider First Name:
MELINDA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APA-C
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:
1215913249
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 NORTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESQUE ISLE
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04769-2291
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-768-4568
Provider Business Mailing Address Fax Number:
207-764-6459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESQUE ISLE
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04769-2291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-768-4568
Provider Business Practice Location Address Fax Number:
207-764-6459
Provider Enumeration Date:
12/21/2005

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: 363A00000X , with the licence number:  PA9103408 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 014558600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com