MEDICARE: MELISSA JOANN DOCTOR PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	799763	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	143585	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	143585	OTHER	TX	TEXAS BOARD ADVANCED PRACTICE PMHNP LICENSE NUMBER
2	799763	OTHER	TX	TEXAS BOARD OF NURSING LICENSE NUMBER

General Provider Information

NPI Number	:	1114414430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA JOANN DOCTOR PMHNP

Provider Business Mailing Address
First Line	:	1482 SENDA DEL SOL
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79911-3045
Country	:	US
Telephone Number	:	915-861-3078
Fax Number	:

Provider Business Practice Location Address
First Line	:	4849 N MESA ST STE 201
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-5919
Country	:	US
Telephone Number	:	915-351-6600
Fax Number	:	915-351-6601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2018
Last Update Date	:	09/12/2025

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