Provider Demographics
NPI:1023578051
Name:ANDERSEN, MELISSA MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MICHELLE
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2471 LUELLA RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-5175
Mailing Address - Country:US
Mailing Address - Phone:469-233-5916
Mailing Address - Fax:
Practice Address - Street 1:3000 N INTERSTATE 35
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-5119
Practice Address - Country:US
Practice Address - Phone:940-898-7144
Practice Address - Fax:940-898-7104
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP191051363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health