1477006369 NPI number — MRS. MELINDA JEANNE MASHBURN RN, CPNP

Table of content: MRS. MELINDA JEANNE MASHBURN RN, CPNP (NPI 1477006369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477006369 NPI number — MRS. MELINDA JEANNE MASHBURN RN, CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASHBURN
Provider First Name:
MELINDA
Provider Middle Name:
JEANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, CPNP
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:
1477006369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 WEST COLLEGE ST.
Provider Second Line Business Mailing Address:
SUITE 60
Provider Business Mailing Address City Name:
GRAPEVINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-488-7334
Provider Business Mailing Address Fax Number:
817-421-6527

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 WEST COLLEGE ST.
Provider Second Line Business Practice Location Address:
SUITE 60
Provider Business Practice Location Address City Name:
GRAPEVINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-488-7334
Provider Business Practice Location Address Fax Number:
817-421-6527
Provider Enumeration Date:
07/27/2016

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: 363LP0200X , with the licence number:  AP102706 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0200X , with the licence number: RN255695 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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