Provider Demographics
NPI:1366911323
Name:PELOQUIN, MELEA J
Entity type:Individual
Prefix:MRS
First Name:MELEA
Middle Name:J
Last Name:PELOQUIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W SUN ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1563
Mailing Address - Country:US
Mailing Address - Phone:606-783-6805
Mailing Address - Fax:606-783-6869
Practice Address - Street 1:555 W SUN ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1563
Practice Address - Country:US
Practice Address - Phone:606-783-6805
Practice Address - Fax:606-783-6869
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
KY2589121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid