Provider Demographics
NPI:1083810543
Name:JACOBSON SCHUSTER, MELANIE B (CPNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:B
Last Name:JACOBSON SCHUSTER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:B
Other - Last Name:SCHUSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PNP
Mailing Address - Street 1:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-4193
Practice Address - Fax:682-885-7956
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX656031363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U87ZMedicare PIN
TX8C9231Medicare ID - Type UnspecifiedIND MEDICARE PIN