Provider Demographics
NPI:1669950655
Name:VANN, MELODIE (FNP-C)
Entity type:Individual
Prefix:
First Name:MELODIE
Middle Name:
Last Name:VANN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:PANHANDLE
Mailing Address - State:TX
Mailing Address - Zip Code:79068-0010
Mailing Address - Country:US
Mailing Address - Phone:806-532-2273
Mailing Address - Fax:806-532-2276
Practice Address - Street 1:SPUR 119 NORTH
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007
Practice Address - Country:US
Practice Address - Phone:806-275-1502
Practice Address - Fax:806-275-1932
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX899141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily