Provider Demographics
NPI:1376230599
Name:FOUTZ, MELANIE R (PMHNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:R
Last Name:FOUTZ
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 WICKERSHAM DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3065
Mailing Address - Country:US
Mailing Address - Phone:254-931-2480
Mailing Address - Fax:
Practice Address - Street 1:2813 WICKERSHAM DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3065
Practice Address - Country:US
Practice Address - Phone:254-931-2480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1115470363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health