Provider Demographics
NPI:1477006369
Name:MASHBURN, MELINDA JEANNE (RN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:JEANNE
Last Name:MASHBURN
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Gender:F
Credentials:RN, CPNP
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Mailing Address - Street 1:1600 WEST COLLEGE ST.
Mailing Address - Street 2:SUITE 60
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051
Mailing Address - Country:US
Mailing Address - Phone:817-488-7334
Mailing Address - Fax:817-421-6527
Practice Address - Street 1:1600 WEST COLLEGE ST.
Practice Address - Street 2:SUITE 60
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051
Practice Address - Country:US
Practice Address - Phone:817-488-7334
Practice Address - Fax:817-421-6527
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP102706363LP0200X
TXRN255695363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics