Provider Demographics
NPI:1790575462
Name:MEJORADO, MISTY ANN (STUDENT FNP)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:ANN
Last Name:MEJORADO
Suffix:
Gender:
Credentials:STUDENT FNP
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:ANN
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2242 RETTA DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-5409
Mailing Address - Country:US
Mailing Address - Phone:361-463-7320
Mailing Address - Fax:136-146-3732
Practice Address - Street 1:2242 RETTA DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-5409
Practice Address - Country:US
Practice Address - Phone:361-463-7320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX795783163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse