Provider Demographics
NPI:1205892221
Name:WILLIAMS, MELODY (PA)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:WILLIAMS
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 1:211 HIGHLAND CROSS DR
Mailing Address - Street 2:STE 275
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-1733
Mailing Address - Country:US
Mailing Address - Phone:281-784-1111
Mailing Address - Fax:
Practice Address - Street 1:211 HIGHLAND CROSS DR
Practice Address - Street 2:STE 275
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-1733
Practice Address - Country:US
Practice Address - Phone:281-784-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX01734363AM0700X
TXPA01734363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y8232OtherBCBSTX
TX194384701Medicaid
TX1205892221OtherTRICARE SOUTH
TX194384702Medicaid
TXTXB103109Medicare PIN
TX1205892221Medicare PIN
TXP00690099Medicare PIN
TX86N212Medicare ID - Type Unspecified
TX194384701Medicaid
TX8K8303Medicare PIN
TX86N134Medicare ID - Type Unspecified
TX194384702Medicaid