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NPI Code Detail

MEDICARE: MELISSA GAYLE NEALY IBCLC, CPM, LM

MEDICARE: MELISSA GAYLE NEALY IBCLC, CPM, LM
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
1174N00000XLactation Consultant (Non-RN)
2176B00000XMidwife99507TX

General Provider Information

NPI Number : 1982175840
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA GAYLE NEALY IBCLC, CPM, LM
Provider Business Mailing Address
First Line : 614 RIVER DELTA LN
Second Line :
City : ROSENBERG
State : TX
Zip : 77469-5790
Country : US
Telephone Number : 832-439-9838
Fax Number :
Provider Business Practice Location Address
First Line : 1305 FM 359 RD STE G
Second Line :
City : RICHMOND
State : TX
Zip : 77406-2024
Country : US
Telephone Number : 832-439-9838
Fax Number : 346-857-0515
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2018
Last Update Date : 02/13/2023

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