Provider Demographics
NPI:1801141718
Name:MELLETT KEITH, AMELIA M (DVM)
Entity type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:M
Last Name:MELLETT KEITH
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8202 N LOOP 1604 W
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2897
Mailing Address - Country:US
Mailing Address - Phone:210-737-7373
Mailing Address - Fax:210-737-7372
Practice Address - Street 1:8202 N LOOP 1604 W
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2897
Practice Address - Country:US
Practice Address - Phone:210-737-7373
Practice Address - Fax:210-737-7372
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13048174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian