Provider Demographics
NPI:1780357418
Name:DE LEON, MELISSA MICHELLE (NP)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MICHELLE
Last Name:DE LEON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 KEENELAND CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-6985
Mailing Address - Country:US
Mailing Address - Phone:469-363-6197
Mailing Address - Fax:
Practice Address - Street 1:4300 MACARTHUR AVE STE 160
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-6544
Practice Address - Country:US
Practice Address - Phone:214-740-2481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1004009363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner