Provider Demographics
NPI:1770020778
Name:HILL, MELINDA (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials: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:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:5414 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1335
Practice Address - Country:US
Practice Address - Phone:903-581-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX368826902Medicaid
TX75-2616977-002OtherTRICARE
TX8216MCOtherBCBS
TXP01812881OtherRAIL ROAD MEDICARE
TX75-2616977-001OtherTRICARE
TXP01812741OtherRAIL ROAD MEDICARE
TX75-0818167-022OtherTRICARE
TX75-2616977-129OtherTRICARE
TX75-2616977-028OtherTRICARE
TX8217MCOtherBCBS
TX368826901Medicaid
TX75-2616977-002OtherTRICARE
TX8217MCOtherBCBS