MEDICARE: MELONY K CATALINE FNP

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	363LA2100X	Acute Care Nurse Practitioner	AP123144	TX
2	363LF0000X	Family Nurse Practitioner	AP123144	TX

General Provider Information

NPI Number	:	1184963472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELONY K CATALINE FNP

Provider Business Mailing Address
First Line	:	3315 UNICORN LAKE BLVD STE 171
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-0127
Country	:	US
Telephone Number	:	940-320-2188
Fax Number	:	940-320-5643

Provider Business Practice Location Address
First Line	:	3315 UNICORN LAKE BLVD STE 171
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-0127
Country	:	US
Telephone Number	:	940-320-2188
Fax Number	:	940-320-5643

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

Provider Enumeration Date	:	02/06/2013
Last Update Date	:	11/23/2020

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