Provider Demographics
NPI:1881143683
Name:JEWELL, MELANIE (MCN, RDN, LD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:JEWELL
Suffix:
Gender:F
Credentials:MCN, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 BROOKVALE DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3750
Mailing Address - Country:US
Mailing Address - Phone:972-437-6598
Mailing Address - Fax:
Practice Address - Street 1:3009 BROOKVALE DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3750
Practice Address - Country:US
Practice Address - Phone:972-437-6598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84507133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered