Provider Demographics
NPI:1881037166
Name:WHEAT, MELANIE JANE
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:JANE
Last Name:WHEAT
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 1:117 REDBUD LN
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-2041
Mailing Address - Country:US
Mailing Address - Phone:918-649-7766
Mailing Address - Fax:
Practice Address - Street 1:34183 COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-9122
Practice Address - Country:US
Practice Address - Phone:918-649-7641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200289470AMedicaid