Basic Information
| Provider Information | |||||||||
| NPI: | 1790387769 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUDKINS | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | GAIL | ||||||||
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| Credential: | LCDC-I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 518 COUNTY ROAD 379 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773287417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815777247 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2929 FM 2920 RD | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773883428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812101500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2020 | ||||||||
| LastUpdateDate: | 11/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.