Provider Demographics
NPI:1114239100
Name:JACOBS, MELISSA FORBES (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:FORBES
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:FORBES
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 4356
Mailing Address - Street 2:DEPARTMENT 667
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4356
Mailing Address - Country:US
Mailing Address - Phone:281-586-3888
Mailing Address - Fax:281-440-2028
Practice Address - Street 1:837 FM 1960 WEST
Practice Address - Street 2:SUITE 105
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-0000
Practice Address - Country:US
Practice Address - Phone:281-586-3888
Practice Address - Fax:281-440-2028
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1535363AM0700X
SCTL1535363AM0700X
TXPA07478363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical