Provider Demographics
NPI:1649515909
Name:BROWN, MELISSA (RD LD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 GRAPEVINE MILLS PKWY APT 836
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-0960
Mailing Address - Country:US
Mailing Address - Phone:318-558-1426
Mailing Address - Fax:
Practice Address - Street 1:3800 GRAPEVINE MILLS PKWY APT 836
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-0960
Practice Address - Country:US
Practice Address - Phone:318-558-1426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82159133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered