Provider Demographics
NPI:1639635196
Name:HALTOM, MELISSA LEE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LEE
Last Name:HALTOM
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 ROLLINGBROOK DR STE 508
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3863
Mailing Address - Country:US
Mailing Address - Phone:281-837-6463
Mailing Address - Fax:281-837-0600
Practice Address - Street 1:1300 ROLLINGBROOK DR STE 508
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3863
Practice Address - Country:US
Practice Address - Phone:281-837-6463
Practice Address - Fax:281-837-0600
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily