Provider Demographics
NPI:1407871676
Name:GRIFFITH, MELANA C (FNPC)
Entity type:Individual
Prefix:
First Name:MELANA
Middle Name:C
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 WEST PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-1812
Mailing Address - Country:US
Mailing Address - Phone:409-886-8700
Mailing Address - Fax:
Practice Address - Street 1:3838 WEST PARK AVENUE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-1812
Practice Address - Country:US
Practice Address - Phone:409-886-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP111526363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ36814Medicare UPIN