Provider Demographics
NPI:1700293255
Name:ROY, MICHELLE GUADALUPE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:GUADALUPE
Last Name:ROY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6701 FANNIN ST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2608
Mailing Address - Country:US
Mailing Address - Phone:832-822-3180
Mailing Address - Fax:832-825-3192
Practice Address - Street 1:6701 FANNIN ST
Practice Address - Street 2:SUITE 610
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2608
Practice Address - Country:US
Practice Address - Phone:832-822-3180
Practice Address - Fax:832-825-3192
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
NC0010-05172363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical