Provider Demographics
NPI:1891113882
Name:CROSS, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:HC 60 BOX 85
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:OK
Mailing Address - Zip Code:74740-9605
Mailing Address - Country:US
Mailing Address - Phone:580-612-1415
Mailing Address - Fax:580-286-2829
Practice Address - Street 1:HC 60 BOX 85
Practice Address - Street 2:
Practice Address - City:HAWORTH
Practice Address - State:OK
Practice Address - Zip Code:74740-9605
Practice Address - Country:US
Practice Address - Phone:580-612-1415
Practice Address - Fax:580-286-2829
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator