Provider Demographics
NPI:1497355929
Name:MEDELLIN, HECTOR III (APRN)
Entity Type:Individual
Prefix:MR
First Name:HECTOR
Middle Name:
Last Name:MEDELLIN
Suffix:III
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6014 COUNTY ROAD 4068
Mailing Address - Street 2:
Mailing Address - City:KEMP
Mailing Address - State:TX
Mailing Address - Zip Code:75143-2600
Mailing Address - Country:US
Mailing Address - Phone:903-603-4322
Mailing Address - Fax:
Practice Address - Street 1:6014 COUNTY ROAD 4068
Practice Address - Street 2:
Practice Address - City:KEMP
Practice Address - State:TX
Practice Address - Zip Code:75143-2600
Practice Address - Country:US
Practice Address - Phone:903-603-4322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1015900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health