Healthcare Provider Details

I. General information

NPI: 1144819293
Provider Name (Legal Business Name): MELISSA PRESTON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 GUY LANE PLZ
DUMAS TX
79029-5542
US

IV. Provider business mailing address

417 NICKLAUS DR SE
RIO RANCHO NM
87124-3483
US

V. Phone/Fax

Practice location:
  • Phone: 806-948-1459
  • Fax: 806-948-1461
Mailing address:
  • Phone: 505-999-8467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1156257
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number62432
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: