MEDICARE: MRS. MELISSA A WEEDE APN

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	731280	TX
2	363LA2100X	Acute Care Nurse Practitioner	000772	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568407260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA A WEEDE APN

Provider Business Mailing Address
First Line	:	PO BOX 1541
Second Line	:
City	:	ARCHER CITY
State	:	TX
Zip	:	76351-1541
Country	:	US
Telephone Number	:	940-525-4410
Fax Number	:	940-525-4410

Provider Business Practice Location Address
First Line	:	912 BURNETT ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-3208
Country	:	US
Telephone Number	:	940-525-4410
Fax Number	:	940-525-4410

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	01/13/2009

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