Provider Demographics
NPI:1265741409
Name:CLAIBORNE, MELODY L (APRN)
Entity type:Individual
Prefix:MS
First Name:MELODY
Middle Name:L
Last Name:CLAIBORNE
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:1 CRIMINAL JUSTICE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-1469
Mailing Address - Country:US
Mailing Address - Phone:936-760-5861
Mailing Address - Fax:
Practice Address - Street 1:1 CRIMINAL JUSTICE DR STE 2
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1469
Practice Address - Country:US
Practice Address - Phone:936-760-5861
Practice Address - Fax:936-538-7721
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2023-05-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704274229163W00000X
TX1108440363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse