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NPI Code Detail

MEDICARE: CARLY MICHELLE MELANCON MSN, APRN, PMHNP-BC

MEDICARE: CARLY MICHELLE MELANCON MSN, APRN, PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAP142178TX

General Provider Information

NPI Number : 1518519610
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLY MICHELLE MELANCON MSN, APRN, PMHNP-BC
Provider Business Mailing Address
First Line : 1801 W KOENIG LN
Second Line :
City : AUSTIN
State : TX
Zip : 78756-1208
Country : US
Telephone Number : 512-808-0543
Fax Number :
Provider Business Practice Location Address
First Line : 1801 W KOENIG LN
Second Line :
City : AUSTIN
State : TX
Zip : 78756-1208
Country : US
Telephone Number : 512-808-0543
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2019
Last Update Date : 04/04/2024

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