Provider Demographics
NPI:1649731175
Name:GILBREATH, MELODY LYNNET
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:LYNNET
Last Name:GILBREATH
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 1:1210 HOLLIDAY ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-4628
Mailing Address - Country:US
Mailing Address - Phone:806-839-2541
Mailing Address - Fax:806-839-2541
Practice Address - Street 1:1210 HOLLIDAY ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-4628
Practice Address - Country:US
Practice Address - Phone:806-839-2541
Practice Address - Fax:806-839-2541
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX155199164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse