Healthcare Provider Details

I. General information

NPI: 1588838031
Provider Name (Legal Business Name): MELANIE RAE PICKERING DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE RAE PICKERING DO

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15601 DALLAS PKWY STE 300
ADDISON TX
75001-6012
US

IV. Provider business mailing address

15601 DALLAS PKWY STE 300
ADDISON TX
75001-6012
US

V. Phone/Fax

Practice location:
  • Phone: 972-682-9218
  • Fax:
Mailing address:
  • Phone: 972-682-9218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA-1816-14
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number02477
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: