Provider Demographics
NPI:1568407260
Name:WEEDE, MELISSA A (APN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:WEEDE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1541
Mailing Address - Street 2:
Mailing Address - City:ARCHER CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76351-1541
Mailing Address - Country:US
Mailing Address - Phone:940-525-4410
Mailing Address - Fax:940-525-4410
Practice Address - Street 1:912 BURNETT ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-3208
Practice Address - Country:US
Practice Address - Phone:940-525-4410
Practice Address - Fax:940-525-4410
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX731280363LA2100X
NV000772363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100501773Medicaid
NV100501773Medicaid
NV101352Medicare ID - Type Unspecified