Desantiago, Melody J A
Desantiago, Melody J A is an individual health care provider with primary practice located at 4102 S Clear Creek Rd Ste 107 , Killeen TX 76549-5954. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Desantiago, Melody J A can be contacted via phone (254) 526-8300.Contact Information
Primary practice address
4102 S Clear Creek Rd Ste 107
Killeen TX 76549-5954
Phone: (254) 526-8300
Fax: (254) 526-4828
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | AP113575 | Texas |
Profile Details
| NPI number | 1982624193 |
|---|---|
| LBN Legal business name | Desantiago, Melody J A |
| Credentials | Certified Pediatric Nurse Practitioner (CPNP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 20th, 2006 |
| Last updated | Jul 21st, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1982624193 | NPPES |
| Texas | MEDICAID | 367312101 |
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