Provider Demographics
NPI:1689274987
Name:HOUGHTON, MICHELE LEE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEE
Last Name:HOUGHTON
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 EDGEFIELD LN
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-3817
Mailing Address - Country:US
Mailing Address - Phone:860-614-5252
Mailing Address - Fax:
Practice Address - Street 1:602 N GOLIAD ST
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-2722
Practice Address - Country:US
Practice Address - Phone:972-772-4606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX897965163W00000X
TX1031404363L00000X
MA204991363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110167330AMedicaid