Provider Demographics
NPI:1952872996
Name:CLAYTON, MELANIE
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:GERTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2312 PLYMOUTH COLONY DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8742
Mailing Address - Country:US
Mailing Address - Phone:469-450-6212
Mailing Address - Fax:
Practice Address - Street 1:2312 PLYMOUTH COLONY DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8742
Practice Address - Country:US
Practice Address - Phone:469-450-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator