Provider Demographics
NPI:1720157027
Name:WELBORN, MONIKA Y (PA)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:Y
Last Name:WELBORN
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 1:1201 BROOKS STREET
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3835
Mailing Address - Country:US
Mailing Address - Phone:281-690-4678
Mailing Address - Fax:
Practice Address - Street 1:1201 BROOKS ST
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3835
Practice Address - Country:US
Practice Address - Phone:281-690-4678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04993363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184483904Medicaid
TXP01070712OtherRR MEDICARE
TX184483902Medicaid
TX145723603Medicaid
TX184483905Medicaid
TX8Y1173OtherBCBS
TX184483901Medicaid
TX8333NDOtherBLUE CROSS BLUE SHIELD
TX184483901Medicaid
TXTXB151088Medicare PIN
TXP01070712OtherRR MEDICARE
TX8L9964Medicare PIN
TX184483904Medicaid
TX184483902Medicaid