MEDICARE: DR. MELINDA E. WENNER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	P1835	TX

General Provider Information

NPI Number	:	1154507630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELINDA E. WENNER DO

Provider Business Mailing Address
First Line	:	2702 N UNIVERSITY DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-2922
Country	:	US
Telephone Number	:	936-205-5805
Fax Number	:	936-205-5997

Provider Business Practice Location Address
First Line	:	4604 NE STALLINGS DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1608
Country	:	US
Telephone Number	:	936-560-5668
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	05/07/2026

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