Provider Demographics
NPI:1831662816
Name:WELDEGHBRIEL, MEKONEN TEKLE
Entity Type:Individual
Prefix:MR
First Name:MEKONEN
Middle Name:TEKLE
Last Name:WELDEGHBRIEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11503 SOUTHWEST FWY
Mailing Address - Street 2:STE C
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77031-3627
Mailing Address - Country:US
Mailing Address - Phone:832-335-4213
Mailing Address - Fax:
Practice Address - Street 1:11503 SOUTHWEST FWY
Practice Address - Street 2:STE C
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77031-3627
Practice Address - Country:US
Practice Address - Phone:832-335-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily