Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP144227 | TX |
NPI | 1023647286 |
---|---|
Provider Name | Ms. Jennifer S Melendez |
First Address | Longview, TX 75601-3507 |
Second Address | Longview, TX 75604-4616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2020 |
Last Update Date | 11/04/2020 |