Provider Demographics
NPI:1821458563
Name:HENSON, MELISSA (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HENSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AP BEUTEL HEALTH CENTER 311 HOUSTON ST BLDG 520
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77843-4728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AP BEUTEL HEALTH CENTER 311 HOUSTON ST BLDG 520
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77843-4728
Practice Address - Country:US
Practice Address - Phone:979-458-8276
Practice Address - Fax:979-458-8310
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10506363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX357083003Medicaid
TX8880NVOtherBLUE CROSS BLUE SHIELD
TX357083003Medicaid
TX513491ZSWDMedicare PIN