Provider Demographics
NPI:1760146179
Name:SCRIVNER, MELISSA ANN (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:SCRIVNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 W RANDOL MILL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2507
Mailing Address - Country:US
Mailing Address - Phone:817-460-0257
Mailing Address - Fax:817-548-0607
Practice Address - Street 1:809 W RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2507
Practice Address - Country:US
Practice Address - Phone:817-460-0257
Practice Address - Fax:817-548-0607
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1012565363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology