Provider Demographics
NPI:1497853675
Name:STAMPER, MELODIANNE (RN, MSN, ACNP)
Entity type:Individual
Prefix:
First Name:MELODIANNE
Middle Name:
Last Name:STAMPER
Suffix:
Gender:F
Credentials:RN, MSN, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:WADLEY TOWER, SUITE 960
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-820-5630
Mailing Address - Fax:214-820-9818
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:WADLEY TOWER, SUITE 960
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-820-5630
Practice Address - Fax:214-820-9818
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX611071363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L20120Medicare PIN