Healthcare Provider Details

I. General information

NPI: 1194657791
Provider Name (Legal Business Name): MELISSA JETER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6220 FM 2920 RD APT 721
SPRING TX
77379-3583
US

IV. Provider business mailing address

6220 FM 2920 RD APT 721
SPRING TX
77379-3583
US

V. Phone/Fax

Practice location:
  • Phone: 469-876-2148
  • Fax:
Mailing address:
  • Phone: 469-876-2148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number1101980
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: