Provider Demographics
NPI:1174986582
Name:MESTER, MELANIE DIANE (MD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:DIANE
Last Name:MESTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:DIANE
Other - Last Name:PREVETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 HERITAGE CIR
Mailing Address - Street 2:
Mailing Address - City:PAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74058-3744
Mailing Address - Country:US
Mailing Address - Phone:918-762-2517
Mailing Address - Fax:918-762-2729
Practice Address - Street 1:1201 HERITAGE CIR
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058-3744
Practice Address - Country:US
Practice Address - Phone:918-762-2517
Practice Address - Fax:918-762-2729
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-02
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32234208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics