Provider Demographics
NPI:1962160028
Name:PECHAL, MELISSA IRENE (FNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:IRENE
Last Name:PECHAL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76501-1951
Mailing Address - Country:US
Mailing Address - Phone:254-654-2212
Mailing Address - Fax:
Practice Address - Street 1:2320 W LOOP 340 STE 200A
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-2454
Practice Address - Country:US
Practice Address - Phone:254-218-5284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1060036363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily