Provider Demographics
NPI:1124791892
Name:PEREZ, MELISSA DARLENE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DARLENE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S AVENUE B
Mailing Address - Street 2:
Mailing Address - City:WORTHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76693-4646
Mailing Address - Country:US
Mailing Address - Phone:903-388-2464
Mailing Address - Fax:
Practice Address - Street 1:101 ANTHONY DR
Practice Address - Street 2:
Practice Address - City:TEAGUE
Practice Address - State:TX
Practice Address - Zip Code:75860-1000
Practice Address - Country:US
Practice Address - Phone:903-388-2464
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
TX1048620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily