Provider Demographics
NPI:1356421556
Name:HARSTON, MELANIE G (DO)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:G
Last Name:HARSTON
Suffix:
Gender:F
Credentials:DO
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 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:731 MARTIN RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2703
Practice Address - Country:US
Practice Address - Phone:817-514-0346
Practice Address - Fax:817-514-0885
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6957208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U87ZOtherBCBSTX GRP PIN
TX1206706OtherUHC PIN
TX4565709OtherAETNA PIN
TX140470100OtherFIRSTCARE PIN
TX232536OtherPHCS PIN
TX89500XOtherBCBSTX IND PIN
TX140442868Medicaid
TX2760457OtherCIGNA PIN
TX060610501Medicaid
TX140442828Medicaid
1750369203OtherGRP NPI NUMBER
TXHARMF90995OtherCCHIP PIN
TX800324OtherFIRSTHEALTH PIN
TX800324OtherFIRSTHEALTH PIN