Provider Demographics
NPI:1588365613
Name:KELLISON, MELANI MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:MELANI
Middle Name:MARIE
Last Name:KELLISON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 S CAPITAL OF TEXAS HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5242
Mailing Address - Country:US
Mailing Address - Phone:512-306-8360
Mailing Address - Fax:855-270-9668
Practice Address - Street 1:912 S CAPITAL OF TEXAS HWY STE 100
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5242
Practice Address - Country:US
Practice Address - Phone:512-306-8360
Practice Address - Fax:855-270-9668
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM60550363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily