Provider Demographics
NPI:1427104215
Name:BURTON, MELISSA K (CST, CSFA, LSA)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:K
Last Name:BURTON
Suffix:
Gender:F
Credentials:CST, CSFA, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10084
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-0084
Mailing Address - Country:US
Mailing Address - Phone:903-646-5350
Mailing Address - Fax:888-501-1092
Practice Address - Street 1:4569 COUNTY ROAD 234D
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-3812
Practice Address - Country:US
Practice Address - Phone:903-646-5350
Practice Address - Fax:888-501-1092
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZS0410X
TXSA00364246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00364OtherTEXAS STATE SURGICAL ASSISTANT LICENSE