Provider Demographics
NPI:1992865570
Name:STORM, MICHELLE (PA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:STORM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 N LAMAR BLVD STE 200A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-5976
Mailing Address - Country:US
Mailing Address - Phone:512-782-9312
Mailing Address - Fax:512-782-9316
Practice Address - Street 1:8300 N LAMAR BLVD STE 200A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-5976
Practice Address - Country:US
Practice Address - Phone:512-782-9312
Practice Address - Fax:512-782-9316
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14382363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant