1922127570 NPI number — DR. MELISSA LYNN KEMP PA-C, DHSC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922127570 NPI number — DR. MELISSA LYNN KEMP PA-C, DHSC

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KEMP

Provider First Name:

MELISSA

Provider Middle Name:

LYNN

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

PA-C, DHSC

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1922127570

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/21/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 841656

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

DALLAS

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

75284-1656

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

903-531-5000

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

5414 S BROADWAY AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

TYLER

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

75703-1335

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

903-581-1601

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

03/28/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 363A00000X , with the licence number:  PA04231 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: P01784198 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 75-0818167-022 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 8454MB . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 287823305 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 75-2616977-001 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 75-2616977-028 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 287823304 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 75-2616977-002 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 75-2616977-129 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 8455MB . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: P01784184 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".