Provider Demographics
NPI:1710600416
Name:MCKENZIE, MELODY
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:MCKENZIE
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 36
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-0001
Mailing Address - Country:US
Mailing Address - Phone:214-549-3910
Mailing Address - Fax:
Practice Address - Street 1:302 FRAZIER ST
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-3426
Practice Address - Country:US
Practice Address - Phone:214-549-3910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
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No372500000XNursing Service Related ProvidersChore Provider