Provider Demographics
NPI:1851492870
Name:LIVELY, MICHELLE ANNE (RNC, WHNP-BC, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANNE
Last Name:LIVELY
Suffix:
Gender:F
Credentials:RNC, WHNP-BC, FNP-C
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:ANNE
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, WHNP-BC, FNP-BC
Mailing Address - Street 1:2279 FRONTIER
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-5943
Mailing Address - Country:US
Mailing Address - Phone:308-261-8992
Mailing Address - Fax:
Practice Address - Street 1:5301 ALAMO PKWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-6771
Practice Address - Country:US
Practice Address - Phone:210-688-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX633908363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health