Basic Information
| Provider Information | |||||||||
| NPI: | 1740343896 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLETCHER | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | CAROL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 428 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | INEZ | ||||||||
| State: | KY | ||||||||
| PostalCode: | 412248931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062982660 | ||||||||
| FaxNumber: | 6062982660 | ||||||||
| Practice Location | |||||||||
| Address1: | 428 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | INEZ | ||||||||
| State: | KY | ||||||||
| PostalCode: | 412248931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062982660 | ||||||||
| FaxNumber: | 6062982660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 04/30/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35820 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1199425 | 01 | CHA | OTHER | 000000230164 | 01 | KY | BLUE CROSS AND BLUE SHIEL | OTHER | 64020159 | 05 | KY | MEDICAID |