Healthcare Provider Details

I. General information

NPI: 1144704727
Provider Name (Legal Business Name): KRISTI MELVEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W VICKERY BLVD
FORT WORTH TX
76104-1025
US

IV. Provider business mailing address

PO BOX 99283
FORT WORTH TX
76199-1383
US

V. Phone/Fax

Practice location:
  • Phone: 682-885-6294
  • Fax: 682-885-1135
Mailing address:
  • Phone: 682-885-6294
  • Fax: 682-885-1135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number677198
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: