Provider Demographics
NPI:1790575462
Name:MEJORADO, MISTY ANN (FNP-C)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:ANN
Last Name:MEJORADO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:ANN
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4254 S ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-2469
Mailing Address - Country:US
Mailing Address - Phone:361-490-2073
Mailing Address - Fax:
Practice Address - Street 1:4254 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-2469
Practice Address - Country:US
Practice Address - Phone:361-490-2073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF08250004363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily