Provider Demographics
NPI:1548659535
Name:MELTON, REBEKAH KORN (CRNA)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:KORN
Last Name:MELTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 HARDING PIKE STE 435
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-4900
Mailing Address - Country:US
Mailing Address - Phone:615-385-3704
Mailing Address - Fax:
Practice Address - Street 1:690 CANTON ST STE 240
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2326
Practice Address - Country:US
Practice Address - Phone:339-204-9516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2332320367500000X
SCAPN-TP 19263367500000X
TN30746367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered