Provider Demographics
NPI:1306860945
Name:MAAG, MELISSA ANN (NP-C)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANN
Last Name:MAAG
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4927 KALE GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-4874
Mailing Address - Country:US
Mailing Address - Phone:505-947-6651
Mailing Address - Fax:
Practice Address - Street 1:4927 KALE GARDEN CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-4874
Practice Address - Country:US
Practice Address - Phone:505-947-6651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX635189363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117-964-001Medicaid
TX8Y3996OtherBCBSTX
TX8Y3685OtherBCBSTX
TX635189OtherNURSE PRACTITIONERS
TX635189OtherNURSE PRACTITIONERS
TX8L10016Medicare PIN
S82314Medicare UPIN
82N828Medicare PIN
TX8Y3685OtherBCBSTX
TX8L10015Medicare PIN
TX8L10017Medicare PIN