Provider Demographics
NPI:1316999352
Name:BECKNELL, MELISSA LYNN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LYNN
Last Name:BECKNELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:GABBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:800 ZORN AVE
Mailing Address - Street 2:GEC-HBPC 11G
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206
Mailing Address - Country:US
Mailing Address - Phone:502-287-5995
Mailing Address - Fax:812-944-7260
Practice Address - Street 1:800 ZORN AVE
Practice Address - Street 2:GEC-HBPC 11G
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206
Practice Address - Country:US
Practice Address - Phone:502-287-5995
Practice Address - Fax:812-944-7260
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4745P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78015971Medicaid
000000391150OtherANTHEM BCBS
KYP00317595OtherRAILROAD MEDICARE
KY0691004Medicare PIN
KYP00317595OtherRAILROAD MEDICARE
KY78015971Medicaid