Provider Demographics
NPI:1548672660
Name:KERLEY, MELANIE
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:KERLEY
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 1:8073 STURKIE RD
Mailing Address - Street 2:
Mailing Address - City:VIOLA
Mailing Address - State:AR
Mailing Address - Zip Code:72583-9751
Mailing Address - Country:US
Mailing Address - Phone:870-895-3546
Mailing Address - Fax:
Practice Address - Street 1:8073 STURKIE RD
Practice Address - Street 2:
Practice Address - City:VIOLA
Practice Address - State:AR
Practice Address - Zip Code:72583-9751
Practice Address - Country:US
Practice Address - Phone:870-895-3546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator