Provider Demographics
NPI:1023116605
Name:VANCE, MELISSA LYNN (APN - BC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:VANCE
Suffix:
Gender:F
Credentials:APN - BC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LYNN
Other - Last Name:LOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN - BC
Mailing Address - Street 1:PO BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4000
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-05-03
Deactivation Date:2020-01-03
Deactivation Code:
Reactivation Date:2020-03-12
Provider Licenses
StateLicense IDTaxonomies
TXAP139996363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS33410751Medicare PIN