Provider Demographics
NPI:1548439904
Name:MALLEY, MELISSA SIMONE (RN, FNP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:SIMONE
Last Name:MALLEY
Suffix:
Gender:F
Credentials:RN, FNP
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Mailing Address - Street 1:2707 NORTH LOOP W
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1051
Mailing Address - Country:US
Mailing Address - Phone:281-936-6000
Mailing Address - Fax:281-936-6416
Practice Address - Street 1:755 N 11TH ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1500
Practice Address - Country:US
Practice Address - Phone:409-924-6975
Practice Address - Fax:409-899-8304
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX661564163WW0000X
TXAP114870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX370446YLJ2Medicare PIN
TX190790901Medicaid