Provider Demographics
NPI:1538240601
Name:RICHBURG, MELANIE ANN (FNP)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:ANN
Last Name:RICHBURG
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:PO BOX 1310
Mailing Address - Street 2:
Mailing Address - City:TAHOKA
Mailing Address - State:TX
Mailing Address - Zip Code:79373-1310
Mailing Address - Country:US
Mailing Address - Phone:806-998-4604
Mailing Address - Fax:
Practice Address - Street 1:2600 LOCKWOOD ST.
Practice Address - Street 2:
Practice Address - City:TAHOKA
Practice Address - State:TX
Practice Address - Zip Code:79373
Practice Address - Country:US
Practice Address - Phone:806-998-4604
Practice Address - Fax:806-561-4047
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX564055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122466104OtherFIRSTCARE
TX1821066820OtherSUPERIOR HEALTH PLAN
TX1942333000Medicaid
TX8N9345OtherBLUECROSS BLUESHEILD
TX092893905OtherFIRSTCARE STAR
TX092893905Medicaid
TX1942333000Medicaid
TX092893905Medicaid