Provider Demographics
NPI:1245677673
Name:SMITH, MELISSA NICOLE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2929 CALDER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1845
Mailing Address - Country:US
Mailing Address - Phone:409-833-9797
Mailing Address - Fax:409-654-6886
Practice Address - Street 1:3570 COLLEGE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4683
Practice Address - Country:US
Practice Address - Phone:409-833-9797
Practice Address - Fax:409-654-6917
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX690893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX355083201Medicaid