Healthcare Provider Details

I. General information

NPI: 1386530129
Provider Name (Legal Business Name): JASMINE E MELTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 TOWNSGATE RD STE 103
WESTLAKE VILLAGE CA
91361-5821
US

IV. Provider business mailing address

2900 TOWNSGATE RD STE 103
WESTLAKE VILLAGE CA
91361-5821
US

V. Phone/Fax

Practice location:
  • Phone: 805-379-9125
  • Fax: 805-379-2311
Mailing address:
  • Phone: 805-379-9125
  • Fax: 805-379-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF03250788
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95125209
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: