Crocker, Melissa Dawn

Crocker, Melissa Dawn is an individual health care provider with primary practice located at 701 Matlock Rd , Mansfield TX 76063-9164. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Crocker, Melissa Dawn can be contacted via phone (817) 453-5437.

Contact Information

Primary practice address
701 Matlock Rd Mansfield TX 76063-9164
Phone: (817) 453-5437
Fax: (817) 453-2714
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 712934 Texas

Profile Details

NPI number 1578861779
LBN Legal business name Crocker, Melissa Dawn
Credentials Certified Pediatric Nurse Practitioner (CPNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 11th, 2011
Last updated Nov 19th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578861779 NPPES
Texas MEDICAID 219895401
Texas Other 219895402

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