Provider Demographics
NPI:1508912502
Name:MENDOZA, MELANIE LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:LYNN
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:LYNN
Other - Last Name:PAFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:520 E. DOUGLAS BLVD.
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702
Mailing Address - Country:US
Mailing Address - Phone:903-593-1721
Mailing Address - Fax:
Practice Address - Street 1:CHRISTUS TRINITY CLINIC
Practice Address - Street 2:520 E. DOUGLAS BLVD.
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702
Practice Address - Country:US
Practice Address - Phone:903-593-1721
Practice Address - Fax:903-525-1259
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX912981363LF0000X
FLARNP 9318647363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-007OtherTRICARE
TX573360YMAFOtherMEDICARE
TX372757002Medicaid
TX8HS129OtherBCBS
TX8HS129OtherBCBS