Provider Demographics
NPI:1780421669
Name:MELVIN, JACKI RAY (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:JACKI
Middle Name:RAY
Last Name:MELVIN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:JACKI
Other - Middle Name:RAY
Other - Last Name:DICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:925 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78416-2347
Mailing Address - Country:US
Mailing Address - Phone:361-500-2993
Mailing Address - Fax:
Practice Address - Street 1:925 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78416-2347
Practice Address - Country:US
Practice Address - Phone:361-500-2993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX780718163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse