Provider Demographics
NPI:1679067151
Name:SPRAY, MELODY (LVN)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:SPRAY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3632 COOKS RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-7612
Mailing Address - Country:US
Mailing Address - Phone:903-407-8366
Mailing Address - Fax:
Practice Address - Street 1:3632 COOKS RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-7612
Practice Address - Country:US
Practice Address - Phone:903-407-8366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX321739164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse