Provider Demographics
NPI:1720560824
Name:FLAKES, MELISSA (LVN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:FLAKES
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 1:2102 LAKEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-1266
Mailing Address - Country:US
Mailing Address - Phone:936-465-1789
Mailing Address - Fax:
Practice Address - Street 1:2102 LAKEVIEW ST
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-1266
Practice Address - Country:US
Practice Address - Phone:936-465-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224301164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse