Provider Demographics
NPI:1376309005
Name:BROWN, MELINDA
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:TX
Mailing Address - Zip Code:76059-0315
Mailing Address - Country:US
Mailing Address - Phone:817-559-4102
Mailing Address - Fax:
Practice Address - Street 1:2917 COUNTY ROAD 805-B
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76031
Practice Address - Country:US
Practice Address - Phone:817-559-4102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1376309005343800000X
TX4TTZY347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1376309005OtherCERTIFIED WHEELCHAIR TRANSPORT