Provider Demographics
NPI:1023018256
Name:KING, MELANIE R (WHCNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:R
Last Name:KING
Suffix:
Gender:F
Credentials:WHCNP
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 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5201 HARRY HINES BLVD
Practice Address - Street 2:WISH TUBAL CLINIC
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7708
Practice Address - Country:US
Practice Address - Phone:214-590-5306
Practice Address - Fax:214-590-2798
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX508283363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138268112Medicaid
TX138268115Medicaid
TX138268118Medicaid
TX138268116Medicaid
TX138268117Medicaid
TX138268113Medicaid
TX138268119Medicaid
TX138268120Medicaid
TX138268108Medicaid
TX8N4800OtherBLUE CROSS BLUE SHIELD
TX138268111Medicaid
TX138268107Medicaid
TX138268114Medicaid
TX82N734Medicare PIN
TX138268112Medicaid