Provider Demographics
NPI:1508859000
Name:BURNEY, MELINDA HEATHCOAT (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:HEATHCOAT
Last Name:BURNEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:LEE
Other - Last Name:HEATHCOAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:FARWELL
Mailing Address - State:TX
Mailing Address - Zip Code:79325-0683
Mailing Address - Country:US
Mailing Address - Phone:806-481-1000
Mailing Address - Fax:806-481-1005
Practice Address - Street 1:125 W PARK AVE
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:TX
Practice Address - Zip Code:79045-4201
Practice Address - Country:US
Practice Address - Phone:806-364-7688
Practice Address - Fax:806-364-7694
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX675086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2003360-02Medicaid
TX801N76OtherBLUE CROSS BLUE SHIELD
TX8F22275Medicare PIN
TX801N76OtherBLUE CROSS BLUE SHIELD