Healthcare Provider Details

I. General information

NPI: 1164996005
Provider Name (Legal Business Name): MELANIE KAREN BEATTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 E WALKER ST
ORLAND CA
95963-2223
US

IV. Provider business mailing address

604 E WALKER ST
ORLAND CA
95963-2223
US

V. Phone/Fax

Practice location:
  • Phone: 530-865-6106
  • Fax:
Mailing address:
  • Phone: 530-865-6106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number128904
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: