Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 508283 | TX |
NPI | 1023018256 |
---|---|
Provider Name | Melanie R. King |
First Address | Dallas, TX 75266-0599 |
Second Address | Dallas, TX 75235-7708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 06/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
138268107 | (05) | TX |
138268108 | (05) | TX |
138268111 | (05) | TX |
138268112 | (05) | TX |
138268113 | (05) | TX |
138268114 | (05) | TX |
138268115 | (05) | TX |
138268116 | (05) | TX |
138268117 | (05) | TX |
138268118 | (05) | TX |
138268119 | (05) | TX |
138268120 | (05) | TX |
8N4800 | BLUE CROSS BLUE SHIELD (01) | TX |
S81393 | (02) | TX |