Healthcare Provider Details

I. General information

NPI: 1790575462
Provider Name (Legal Business Name): MISTY ANN MEJORADO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISTY ANN JENNINGS RN

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4254 S ALAMEDA ST
CORPUS CHRISTI TX
78412-2469
US

IV. Provider business mailing address

4254 S ALAMEDA ST
CORPUS CHRISTI TX
78412-2469
US

V. Phone/Fax

Practice location:
  • Phone: 361-490-2073
  • Fax:
Mailing address:
  • Phone: 361-490-2073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1213554
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: