Provider Demographics
NPI:1427393792
Name:WYNN VELA, MICA MALEIGH (FNP-C)
Entity Type:Individual
Prefix:
First Name:MICA
Middle Name:MALEIGH
Last Name:WYNN VELA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 VENETO CT
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-5006
Mailing Address - Country:US
Mailing Address - Phone:832-724-4283
Mailing Address - Fax:832-200-3636
Practice Address - Street 1:2801 VENETO CT
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573
Practice Address - Country:US
Practice Address - Phone:832-724-4283
Practice Address - Fax:832-200-3636
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122501225400000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner