Provider Demographics
NPI:1275921579
Name:GUERRY, MELINDA (PA)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:GUERRY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 E MOSSY OAKS RD
Mailing Address - Street 2:STE 680
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-1812
Mailing Address - Country:US
Mailing Address - Phone:281-537-0300
Mailing Address - Fax:832-381-2062
Practice Address - Street 1:2255 E MOSSY OAKS RD
Practice Address - Street 2:STE 680
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-1812
Practice Address - Country:US
Practice Address - Phone:281-537-0300
Practice Address - Fax:832-381-2062
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09559207Q00000X, 208000000X, 363A00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA09559OtherMEDICAL LICENSE