Provider Demographics
NPI:1326602301
Name:WHITE, MELANIE J N (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:J N
Last Name:WHITE
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 1:109 STARDUST TRL
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:TX
Mailing Address - Zip Code:79562-3689
Mailing Address - Country:US
Mailing Address - Phone:325-428-6953
Mailing Address - Fax:
Practice Address - Street 1:717 MEADE ST STE 100
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-5100
Practice Address - Country:US
Practice Address - Phone:325-864-4919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily