Provider Demographics
NPI:1093292096
Name:MATEJ, MELODY LANE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:LANE
Last Name:MATEJ
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 1:201 CAMPBELL CT
Mailing Address - Street 2:
Mailing Address - City:FATE
Mailing Address - State:TX
Mailing Address - Zip Code:75189-4998
Mailing Address - Country:US
Mailing Address - Phone:469-980-6305
Mailing Address - Fax:
Practice Address - Street 1:1413 OATES DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-1345
Practice Address - Country:US
Practice Address - Phone:972-613-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138189363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP138189OtherTEXAS BOARD OF NURSING