Provider Demographics
NPI:1639719123
Name:LAWHORN, MELINDA FAYE (APRN)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:FAYE
Last Name:LAWHORN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4261 BARNS DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:TX
Mailing Address - Zip Code:75422-2297
Mailing Address - Country:US
Mailing Address - Phone:903-268-1594
Mailing Address - Fax:
Practice Address - Street 1:5005 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6364
Practice Address - Country:US
Practice Address - Phone:903-455-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX688636163WC0200X
TX1028930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine