Provider Demographics
NPI:1639396781
Name:BELL, MELANIE K (PA)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:K
Last Name:BELL
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 1:2501 JIMMY JOHNSON BLVD STE 501B
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2013
Mailing Address - Country:US
Mailing Address - Phone:409-729-2555
Mailing Address - Fax:409-729-2542
Practice Address - Street 1:2501 JIMMY JOHNSON BLVD STE 501B
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2013
Practice Address - Country:US
Practice Address - Phone:409-729-2555
Practice Address - Fax:409-729-2542
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03511363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03511OtherSTATE LICENSE