Provider Demographics
NPI:1104512698
Name:KIMMEY, MELODY ANNE
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:ANNE
Last Name:KIMMEY
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 1:322 CAPTAIN DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:DE
Mailing Address - Zip Code:19934-1748
Mailing Address - Country:US
Mailing Address - Phone:302-598-8914
Mailing Address - Fax:
Practice Address - Street 1:322 CAPTAIN DAVIS DR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:DE
Practice Address - Zip Code:19934-1748
Practice Address - Country:US
Practice Address - Phone:302-598-8914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0040104163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care