Provider Demographics
NPI:1588649370
Name:DENNIS, MELYNDA GAYE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MELYNDA
Middle Name:GAYE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5219 CITY BANK PKWY
Mailing Address - Street 2:SUITE 135
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3544
Mailing Address - Country:US
Mailing Address - Phone:806-761-0334
Mailing Address - Fax:806-722-2908
Practice Address - Street 1:2703 82ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1429
Practice Address - Country:US
Practice Address - Phone:806-761-0428
Practice Address - Fax:806-712-0168
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT001657363AM0700X
TXPA01477363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS64656Medicare UPIN