Provider Demographics
NPI:1316135783
Name:OSBORNE, MELINDA J
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:J
Last Name:OSBORNE
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:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-0158
Mailing Address - Country:US
Mailing Address - Phone:606-598-5564
Mailing Address - Fax:
Practice Address - Street 1:120 RICHMOND STREET
Practice Address - Street 2:
Practice Address - City:MT. VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456
Practice Address - Country:US
Practice Address - Phone:606-256-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1888133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist