Healthcare Provider Details

I. General information

NPI: 1174617955
Provider Name (Legal Business Name): MELINDA DIANE HUFFMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3324 HALL JOHNSON RD
GRAPEVINE TX
76051-6816
US

IV. Provider business mailing address

3324 HALL JOHNSON RD
GRAPEVINE TX
76051-6816
US

V. Phone/Fax

Practice location:
  • Phone: 817-481-2629
  • Fax:
Mailing address:
  • Phone: 817-481-2629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP110123
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: