Provider Demographics
NPI:1013040914
Name:SCHOCK, MELINDA SUE (PA-C)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
Last Name:SCHOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 S COULTER ST STE 101
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1761
Mailing Address - Country:US
Mailing Address - Phone:806-677-7952
Mailing Address - Fax:806-353-6081
Practice Address - Street 1:1215 S COULTER ST STE 101
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1761
Practice Address - Country:US
Practice Address - Phone:806-677-7952
Practice Address - Fax:806-353-6081
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05043363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant