Healthcare Provider Details

I. General information

NPI: 1649639881
Provider Name (Legal Business Name): MRS. MELANIE GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17448 HIGHWAY 3 STE 200
WEBSTER TX
77598-4140
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265-7028
US

V. Phone/Fax

Practice location:
  • Phone: 832-505-1748
  • Fax: 713-436-3639
Mailing address:
  • Phone: 409-747-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP130149
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: