1467925040 NPI number — KAYLA MELENDEZ FNP

Table of content: KAYLA MELENDEZ FNP (NPI 1467925040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467925040 NPI number — KAYLA MELENDEZ FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MELENDEZ
Provider First Name:
KAYLA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1467925040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5309 SHERWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79707-1523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
324-230-7677
Provider Business Mailing Address Fax Number:
432-686-0664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6010 TX-191
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79762-5070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-230-7677
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/07/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  F08181352 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F08181352 . This is a "FNP CERTIFICATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com