Healthcare Provider Details

I. General information

NPI: 1437032729
Provider Name (Legal Business Name): LONE STAR LACTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2025
Last Update Date: 07/26/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 S ELM ST
KELLER TX
76248-2257
US

IV. Provider business mailing address

14517 MEADOWLAND CIR
NEWARK TX
76071-9103
US

V. Phone/Fax

Practice location:
  • Phone: 817-793-1748
  • Fax:
Mailing address:
  • Phone: 817-793-1748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: MELANIE VAN NOY
Title or Position: OWNER/MANAGER
Credential: MS, CCC-SLP, IBCLC
Phone: 817-793-1748