Healthcare Provider Details

I. General information

NPI: 1639719123
Provider Name (Legal Business Name): MELINDA FAYE LAWHORN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 LIVE OAK ST
GREENVILLE TX
75402-6364
US

IV. Provider business mailing address

4261 BARNS DR
CAMPBELL TX
75422-2297
US

V. Phone/Fax

Practice location:
  • Phone: 903-455-3500
  • Fax:
Mailing address:
  • Phone: 903-268-1594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number688636
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1028930
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: