MEDICARE: MELISSA K LYNN WHNP-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
1	363LW0102X	Women's Health Nurse Practitioner	573023	TX

General Provider Information

NPI Number	:	1881921146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA K LYNN WHNP-BC

Provider Business Mailing Address
First Line	:	1121 ROSS AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76706-1755
Country	:	US
Telephone Number	:	254-759-5750
Fax Number	:	254-759-5765

Provider Business Practice Location Address
First Line	:	1121 ROSS AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76706-1755
Country	:	US
Telephone Number	:	254-759-5750
Fax Number	:	254-759-5765

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

Provider Enumeration Date	:	11/06/2009
Last Update Date	:	01/11/2011

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