Basic Information
| Provider Information | |||||||||
| NPI: | 1447320577 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELTON | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | A.R.N.P. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MASON | ||||||||
| OtherFirstName: | PAULA | ||||||||
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| OtherNamePrefix: | |||||||||
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| OtherCredential: | A.R.N.P. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 7448 | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420027448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703343131 | ||||||||
| FaxNumber: | 2703313173 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 N 4TH ST | ||||||||
| Address2: | |||||||||
| City: | BARLOW | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420249579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703343131 | ||||||||
| FaxNumber: | 2703343173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 06/23/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3003517 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 78007390 | 05 | KY | MEDICAID |