Provider Demographics
NPI:1891120077
Name:BYLES, MELISHA FAYE
Entity Type:Individual
Prefix:MS
First Name:MELISHA
Middle Name:FAYE
Last Name:BYLES
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 1:1118 LINDA LN
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-4161
Mailing Address - Country:US
Mailing Address - Phone:405-343-4619
Mailing Address - Fax:
Practice Address - Street 1:1118 LINDA LN
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-4161
Practice Address - Country:US
Practice Address - Phone:405-343-4619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK00000000000000000000251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000000000000000000Medicaid