Basic Information
| Provider Information | |||||||||
| NPI: | 1922681022 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARRASCO | ||||||||
| FirstName: | MELISA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CCM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9102 SPIGEL WAY | ||||||||
| Address2: | |||||||||
| City: | CONVERSE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781090210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2108086524 | ||||||||
| FaxNumber: | 2105392084 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 SCHOFIELD RD BLDG 1179 | ||||||||
| Address2: | |||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782347577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2108086524 | ||||||||
| FaxNumber: | 2105392075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2021 | ||||||||
| LastUpdateDate: | 05/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0400X | 504829 | TX | Y | Nursing Service Providers | Registered Nurse | Case Management |
No ID Information.