Provider Demographics
NPI:1548808470
Name:MELTON, KIMBERLY DIANNE (RD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DIANNE
Last Name:MELTON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6531 LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074-1108
Mailing Address - Country:US
Mailing Address - Phone:989-858-6915
Mailing Address - Fax:
Practice Address - Street 1:6531 LAPEER RD
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:MI
Practice Address - Zip Code:48074-1108
Practice Address - Country:US
Practice Address - Phone:989-858-6915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
808414