Provider Demographics
NPI:1992000418
Name:BINKLEY, MELISSA H (LSA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:H
Last Name:BINKLEY
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 MADISON OAK DR
Mailing Address - Street 2:STE 610
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3924
Mailing Address - Country:US
Mailing Address - Phone:210-352-5346
Mailing Address - Fax:210-352-5367
Practice Address - Street 1:540 MADISON OAK DR
Practice Address - Street 2:STE 610
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3924
Practice Address - Country:US
Practice Address - Phone:210-352-5346
Practice Address - Fax:210-352-5367
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00553363AS0400X
TX10-283246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10-283OtherBOARD CERTIFICATION
TX8418NVOtherBCBSTX
TXSA00553OtherLSA LICENSE
TX12678891OtherCAQH