Provider Demographics
NPI:1699308908
Name:O'BRYAN, MELISSA A
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:O'BRYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 COLLINS RD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-3833
Mailing Address - Country:US
Mailing Address - Phone:501-304-3196
Mailing Address - Fax:
Practice Address - Street 1:2631 COLLINS RD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-3833
Practice Address - Country:US
Practice Address - Phone:501-304-3196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX901099163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse