Provider Demographics
NPI:1053377531
Name:CHAVEZ, MELINDA (FNP)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 MARSHA SHARP FREEWAY
Mailing Address - Street 2:DOOR #1
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-2504
Mailing Address - Country:US
Mailing Address - Phone:806-797-2139
Mailing Address - Fax:806-797-3105
Practice Address - Street 1:4321 MARSHA SHARP FREEWAY
Practice Address - Street 2:DOOR #1
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2504
Practice Address - Country:US
Practice Address - Phone:806-797-2139
Practice Address - Fax:806-797-3105
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX620800363L00000X, 363LF0000X
TXAP111923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177135401Medicaid
TX00670VMedicare PIN
P87222Medicare UPIN