Provider Demographics
NPI:1255529905
Name:BOWEN, MELANIE D (NP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:D
Last Name:BOWEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:D
Other - Last Name:GEISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9229 LBJ FWY
Mailing Address - Street 2:ATTN: POST ACUTE
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3405
Mailing Address - Country:US
Mailing Address - Phone:682-236-3656
Mailing Address - Fax:214-570-1692
Practice Address - Street 1:113 PLEASANT VALLEY DR STE 210
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-5683
Practice Address - Country:US
Practice Address - Phone:830-267-4575
Practice Address - Fax:830-267-4575
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP116315363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4860806OtherAETNA
TX189644110Medicaid
TX8KL342OtherBCBS
TX189644108Medicaid
TX189644102Medicaid
TX189644101Medicaid
TX189644108Medicaid
TX8L10020Medicare PIN
TX189644101Medicaid
TX189644104Medicaid
TX8L10021Medicare PIN
TX189644102Medicaid
TX8L9593Medicare PIN