Provider Demographics
NPI:1295919454
Name:LUCKAY, MELINDA L (CRNP)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:L
Last Name:LUCKAY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:L
Other - Last Name:EASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4515 BRAMBLETON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3436
Mailing Address - Country:US
Mailing Address - Phone:540-777-6807
Mailing Address - Fax:540-777-6809
Practice Address - Street 1:4515 BRAMBLETON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3436
Practice Address - Country:US
Practice Address - Phone:540-777-6807
Practice Address - Fax:540-777-6809
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168899363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health