Provider Demographics
NPI:1487301800
Name:KILPATRICK, MELISSA (LADAC II, ADS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KILPATRICK
Suffix:
Gender:F
Credentials:LADAC II, ADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 NW BROAD ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2390
Mailing Address - Country:US
Mailing Address - Phone:629-207-4448
Mailing Address - Fax:615-956-7578
Practice Address - Street 1:1139 NW BROAD ST STE 102
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2390
Practice Address - Country:US
Practice Address - Phone:629-207-4448
Practice Address - Fax:615-956-7578
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-05
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1304101YA0400X
TN01304101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)