Provider Demographics
NPI:1013780980
Name:BEBOUT, MELANIE JILL (APRN)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:JILL
Last Name:BEBOUT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 GOODMAN AVE APT 3304
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6627
Mailing Address - Country:US
Mailing Address - Phone:806-626-8014
Mailing Address - Fax:
Practice Address - Street 1:4940 GOODMAN AVE APT 3304
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-6627
Practice Address - Country:US
Practice Address - Phone:806-626-8014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1140598363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care