MEDICARE: MRS. MELISSA KAYE FULGENCIO PARAMEDICAL ARTIST

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	174400000X	Specialist	1003787	TX
2	246Z00000X	Other Specialist/Technologist

General Provider Information

NPI Number	:	1437926284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA KAYE FULGENCIO PARAMEDICAL ARTIST

Provider Business Mailing Address
First Line	:	240 HARWOOD RD STE 3
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-4189
Country	:	US
Telephone Number	:	844-407-3733
Fax Number	:	407-650-2754

Provider Business Practice Location Address
First Line	:	6221 COLLEYVILLE BLVD STE 100
Second Line	:
City	:	COLLEYVILLE
State	:	TX
Zip	:	76034-6273
Country	:	US
Telephone Number	:	844-407-3733
Fax Number	:

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

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	03/11/2026

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