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General NPI Number Information
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NPI Number | 1417343039
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Entity Type | Individual
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Provider Name | MELISSA LEANN HEARRELL APRN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 02/11/2016
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Provider Practice Location Address
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Address Line | 7711 LOUIS PASTEUR DR SUITE 406
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3415
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Country | US
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Telephone | 210-614-6673
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Fax | 210-614-5340
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Provider Business Mailing Address
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Address Line | 7711 LOUIS PASTEUR DR SUITE 406
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3415
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Country | US
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Telephone | 210-614-6673
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Fax | 210-614-5340
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP127944
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License Number State | TX
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