Provider Demographics
NPI:1801397245
Name:MORRIS, MELODY ANN
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:ANN
Last Name:MORRIS
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 1:131 MEMORY LN APT 608
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-6132
Mailing Address - Country:US
Mailing Address - Phone:903-724-3057
Mailing Address - Fax:
Practice Address - Street 1:131 MEMORY LN APT 608
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-6132
Practice Address - Country:US
Practice Address - Phone:903-724-3057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189892164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse