Provider Demographics
NPI:1821558859
Name:MATEO, MELODY C (FNP)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:C
Last Name:MATEO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 E WHITESTONE BLVD BLDG P100
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7884
Mailing Address - Country:US
Mailing Address - Phone:512-229-0860
Mailing Address - Fax:
Practice Address - Street 1:1335 E WHITESTONE BLVD BLDG P100
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7884
Practice Address - Country:US
Practice Address - Phone:512-229-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140484207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine