Provider Demographics
NPI:1255018354
Name:MENDES, INYOUNG LUNA (FNP-C)
Entity type:Individual
Prefix:
First Name:INYOUNG
Middle Name:LUNA
Last Name:MENDES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:INYOUNG
Other - Middle Name:LUNA
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:6708 BAYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5775
Mailing Address - Country:US
Mailing Address - Phone:254-630-3533
Mailing Address - Fax:
Practice Address - Street 1:6708 BAYBERRY DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-5775
Practice Address - Country:US
Practice Address - Phone:254-630-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1127006363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily