Provider Demographics
NPI:1922127570
Name:KEMP, MELISSA LYNN (PA-C, DHSC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LYNN
Last Name:KEMP
Suffix:
Gender:F
Credentials:PA-C, DHSC
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:2007-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04231363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01784198OtherRAIL ROAD MEDICARE
TX75-0818167-022OtherTRICARE
TX8454MBOtherBCBS
TX287823305Medicaid
TX75-2616977-001OtherTRICARE
TX75-2616977-028OtherTRICARE
TX287823304Medicaid
TX75-2616977-002OtherTRICARE
TX75-2616977-129OtherTRICARE
TX8455MBOtherBCBS
TXP01784184OtherRAIL ROAD MEDICARE
TX75-2616977-001OtherTRICARE
TX552164YMAFMedicare PIN