Healthcare Provider Details

I. General information

NPI: 1457634289
Provider Name (Legal Business Name): MELODY R VERNER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELODY REDDING

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 MEDICAL DR SUITE 500
SAN ANTONIO TX
78229-3342
US

IV. Provider business mailing address

4330 MEDICAL DR SUITE 500
SAN ANTONIO TX
78229-3342
US

V. Phone/Fax

Practice location:
  • Phone: 210-576-5306
  • Fax: 210-694-0645
Mailing address:
  • Phone: 210-576-5306
  • Fax: 210-694-0645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number717854
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP120910
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: