Provider Demographics
NPI:1619040367
Name:MEISENBACH, COREY EUGENE (RN, MSN, ACNP)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:EUGENE
Last Name:MEISENBACH
Suffix:
Gender:M
Credentials:RN, MSN, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 1601
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-5141
Mailing Address - Fax:
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1601
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX634743363LA2100X
TXAP111012363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282222301Medicaid
TX8555NDOtherBCBS
TX282222302Medicaid
TX1619040367OtherBLUE CROSS BLUE SHIELD
TX282222303Medicaid
TX845N84OtherBCBS
TXP01481722OtherRR MEDICARE
TXP01481722OtherRR MEDICARE
TXTXB128340Medicare PIN
TX282222302Medicaid
TX282222303Medicaid