Provider Demographics
NPI:1285677682
Name:MADISON, MELINDA (PHD, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:MADISON
Suffix:
Gender:F
Credentials:PHD, WHNP-BC
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:MADISON
Other - Last Name:CODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP WOMEN'S HEALTH
Mailing Address - Street 1:PO BOX 19329
Mailing Address - Street 2:605 S. WEST ST.
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76019-0329
Mailing Address - Country:US
Mailing Address - Phone:817-272-2771
Mailing Address - Fax:817-272-3829
Practice Address - Street 1:605 S WEST ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76019-0329
Practice Address - Country:US
Practice Address - Phone:817-272-2771
Practice Address - Fax:817-272-3829
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX249237363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137801011Medicaid
TX137801012Medicaid
TX137801011Medicaid
TX137801012Medicaid
TXTXB117843Medicare PIN