MEDICARE: KET MELVIN-HARRIS DNP, FNP-C, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP121985	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	848700	NV

General Provider Information

NPI Number	:	1588911705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KET MELVIN-HARRIS DNP, FNP-C, PMHNP-BC

Provider Business Mailing Address
First Line	:	750 E US HIGHWAY 80 STE 200-612
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-8722
Country	:	US
Telephone Number	:	469-686-8195
Fax Number	:	469-857-8492

Provider Business Practice Location Address
First Line	:	2455 ROBINSON RD STE 100
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75051-3852
Country	:	US
Telephone Number	:	469-626-8195
Fax Number	:	469-857-8492

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	10/02/2025

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