Provider Demographics
NPI:1114417037
Name:MELLO, REDSTAR TYNER (FNP-C)
Entity Type:Individual
Prefix:
First Name:REDSTAR
Middle Name:TYNER
Last Name:MELLO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:MELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1151 S HIGHWAY 160
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-4700
Mailing Address - Country:US
Mailing Address - Phone:775-727-8900
Mailing Address - Fax:775-537-2090
Practice Address - Street 1:1151 S HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048
Practice Address - Country:US
Practice Address - Phone:775-727-8900
Practice Address - Fax:775-537-2090
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily