Provider Demographics
NPI:1790962041
Name:BASSETT, MELISSA MAY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MAY
Last Name:BASSETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MAY
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7630 FRY RD
Mailing Address - Street 2:STE 300
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3376
Mailing Address - Country:US
Mailing Address - Phone:281-463-1400
Mailing Address - Fax:281-463-1432
Practice Address - Street 1:4140 COUNTY ROAD 101 N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-2308
Practice Address - Country:US
Practice Address - Phone:763-478-4612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5234444-3102RN164X00000X
UT5234444-4405363LF0000X
UT5234444-4405APRN363LF0000X
TXAP117247363LF0000X
MNCNP2945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400282061Medicare PIN