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General NPI Number Information
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NPI Number | 1356421556
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Entity Type | Individual
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Provider Name | MELANIE G HARSTON DO
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Gender | Female
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 07/26/2019
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Provider Practice Location Address
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Address Line | 731 MARTIN RD
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City | HURST
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State | TX
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Zip | 76054-2703
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Country | US
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Telephone | 817-514-0346
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Fax | 817-514-0885
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Provider Business Mailing Address
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Address Line | PO BOX 99371
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City | FORT WORTH
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State | TX
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Zip | 76199-0371
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Country | US
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Telephone | 682-885-1855
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Fax | 682-885-7347
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | J6957
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License Number State | TX
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