Provider Demographics
NPI:1649559535
Name:CLARKE, MELODY N (RN)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:N
Last Name:CLARKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 E ESPERANZA AVE
Mailing Address - Street 2:STE. A
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-1456
Mailing Address - Country:US
Mailing Address - Phone:956-458-7887
Mailing Address - Fax:
Practice Address - Street 1:833 E ESPERANZA AVE
Practice Address - Street 2:STE. A
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-1456
Practice Address - Country:US
Practice Address - Phone:956-458-7887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199538301Medicaid