Provider Demographics
NPI:1023055845
Name:FANELLI-JORDAN, MELISSA (APRN)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:
Last Name:FANELLI-JORDAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:FANELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:705 QUAIL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-1608
Mailing Address - Country:US
Mailing Address - Phone:806-353-6400
Mailing Address - Fax:806-358-6776
Practice Address - Street 1:705 QUAIL CREEK DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1608
Practice Address - Country:US
Practice Address - Phone:806-353-6400
Practice Address - Fax:806-358-6776
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX616781363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175640502Medicaid
TX175640502Medicaid