Provider Demographics
NPI:1841687308
Name:DE CASTRO, MICHELLY R (BSN, MSN)
Entity type:Individual
Prefix:
First Name:MICHELLY
Middle Name:R
Last Name:DE CASTRO
Suffix:
Gender:F
Credentials:BSN, MSN
Other - Prefix:
Other - First Name:MICHELLY
Other - Middle Name:R
Other - Last Name:ABREU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, MSN
Mailing Address - Street 1:PO BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4000
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1072057363L00000X
NYF306428-1363LA2200X
NYF340911-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology