Provider Demographics
NPI:1568762524
Name:WILSON, MELANIE JAYNE (ACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:JAYNE
Last Name:WILSON
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8820 GUSTINE DR
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-3651
Mailing Address - Country:US
Mailing Address - Phone:210-364-6953
Mailing Address - Fax:
Practice Address - Street 1:8820 GUSTINE DR
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-3651
Practice Address - Country:US
Practice Address - Phone:210-364-6953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX592746363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care