Healthcare Provider Details

I. General information

NPI: 1174986582
Provider Name (Legal Business Name): MELANIE DIANE MESTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELANIE DIANE PREVETT

II. Dates (important events)

Enumeration Date: 04/02/2016
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 HERITAGE CIR
PAWNEE OK
74058-3744
US

IV. Provider business mailing address

1201 HERITAGE CIR
PAWNEE OK
74058-3744
US

V. Phone/Fax

Practice location:
  • Phone: 918-762-2517
  • Fax: 918-762-2729
Mailing address:
  • Phone: 918-762-2517
  • Fax: 918-762-2729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32234
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: