Provider Demographics
NPI:1255939740
Name:GEORGE, MELISSA WALLES (MSN, APRN, AGNP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:WALLES
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MSN, APRN, AGNP-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:WALLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-0402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 PARKER SQ STE 265
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-7449
Practice Address - Country:US
Practice Address - Phone:469-348-0670
Practice Address - Fax:469-348-0672
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1003502363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health