MEDICARE: MELISSA JETER

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	164X00000X	Licensed Vocational Nurse	1101980	TX

General Provider Information

NPI Number	:	1194657791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA JETER

Provider Business Mailing Address
First Line	:	6220 FM 2920 RD APT 721
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-3583
Country	:	US
Telephone Number	:	469-876-2148
Fax Number	:

Provider Business Practice Location Address
First Line	:	6220 FM 2920 RD APT 721
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-3583
Country	:	US
Telephone Number	:	469-876-2148
Fax Number	:

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

Provider Enumeration Date	:	05/30/2026
Last Update Date	:	05/30/2026

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Directions to “ MELISSA JETER ” Practice Location

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