Basic Information
Provider Information
NPI: 1134659964
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SLOAN
FirstName: MELINDA
MiddleName: KAYE
NamePrefix:  
NameSuffix:  
Credential: R.N.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6350 W ANDREW JOHNSON HWY DEPT 100
Address2:  
City: TALBOTT
State: TN
PostalCode: 378778605
CountryCode: US
TelephoneNumber: 8003553565
FaxNumber: 4237142355
Practice Location
Address1: 1032 MCCALLIE AVE
Address2:  
City: CHATTANOOGA
State: TN
PostalCode: 374032800
CountryCode: US
TelephoneNumber: 4232664588
FaxNumber: 8653420103
Other Information
ProviderEnumerationDate: 06/14/2017
LastUpdateDate: 06/14/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN209543TNY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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