Provider Demographics
NPI:1730379611
Name:DURHAM, MELANIE MILLER (NP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:MILLER
Last Name:DURHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:DAWN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:621 N HALL ST STE 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-1316
Mailing Address - Country:US
Mailing Address - Phone:469-800-7400
Mailing Address - Fax:469-800-7410
Practice Address - Street 1:621 N HALL ST STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1316
Practice Address - Country:US
Practice Address - Phone:469-800-7400
Practice Address - Fax:469-800-7410
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP116202363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y2615OtherBCBS
TX186610501Medicaid
TX476834YKPWMedicare PIN
TX8Y2615OtherBCBS