Provider Demographics
NPI:1063640985
Name:HALE, MELISSA MARIE (PA-C)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MARIE
Last Name:HALE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 WILDCAT LN
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8950
Mailing Address - Country:US
Mailing Address - Phone:606-261-5344
Mailing Address - Fax:818-337-3798
Practice Address - Street 1:300 CARRERA DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-6303
Practice Address - Country:US
Practice Address - Phone:606-657-2079
Practice Address - Fax:818-337-3798
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1567363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01439783OtherRR MEDICARE
KYPA1567OtherMEDICAL LICENSE
KY7100285080Medicaid
KYPA1567OtherMEDICAL LICENSE