Provider Demographics
NPI:1639396781
Name:BELL, MELANIE K (PA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:K
Last Name:BELL
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 1:3135 SABA LN
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-5421
Mailing Address - Country:US
Mailing Address - Phone:409-722-0000
Mailing Address - Fax:409-721-5539
Practice Address - Street 1:3135 SABA LN
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-5421
Practice Address - Country:US
Practice Address - Phone:409-722-0000
Practice Address - Fax:409-721-5539
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03511363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03511OtherSTATE LICENSE