Provider Demographics
NPI:1861130130
Name:CHAN, MELISSA JANE (APRN-PNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANE
Last Name:CHAN
Suffix:
Gender:F
Credentials:APRN-PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 E HWY 290 STE 420
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8901 VERTEX BLVD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78747-2792
Practice Address - Country:US
Practice Address - Phone:512-231-5150
Practice Address - Fax:512-406-6262
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1075010363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1075010OtherSTATE LICENSE