Individual provider Active NPI

Melissa Crosman, FNP

  • Family Nurse Practitioner
  • Tyler, TX
National Provider Identifier
1740897479
Registry record updated Apr 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1097800 Issued in TX
Practice address
4111 University Blvd
Tyler, TX 75701-6623
Phone
(903) 266-3400
NPI assigned
Sep 27, 2020
Last updated
Apr 27, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1097800 TX Primary
Registered Nurse 163W00000X 923240 TX

Addresses

Primary practice location

4111 University Blvd
Tyler, TX 75701-6623

Mailing address

2316 S Boldt Ave
Tyler, TX 75701-5922
Phone (903) 504-9204

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230518003738 TX Practitioner - Nurse Practitioner 8325404221 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Palliative CareGroup PAC ID 2062691223, 10 clinicians

Practice addresses (Care Compare)

4111 University Blvd
Tyler, TX 75701-6623
Phone (903) 566-9872

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
923240TXMDRegistered Nurse
1097800TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Palliative Care CurrentSince Apr 1, 2023 Accepting new patients

Locations

4111 University Blvd
Tyler, TX 75701
Phone (903) 266-3400

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682553600000",
    "number": "1740897479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2316 S BOLDT AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757015922",
            "telephone_number": "903-504-9204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4111 UNIVERSITY BLVD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757016623",
            "telephone_number": "903-266-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROSMAN",
        "first_name": "MELISSA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-27",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1097800",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "923240",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.