PROF. MANDY MORENO MICHEAUX (NPI# 1881741346) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881741346 |
| Entity Type | Individual |
| Full Name | PROF. MANDY MORENO MICHEAUX |
| Credential | PA-C |
| Practice Address |
228 Saint George St Gonzales TX 78629-3910 |
| Mailing Address |
623 Clark St Gonzales TX 78629-3701 |
| Practice Telephone | 8306726511 |
| Mailing Telephone | 4692224059 |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2007-07-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA04403 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
228 SAINT GEORGE ST |
| City | GONZALES |
| State | TX |
| Zip Code | 78629-3910 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184626871 | Roland A Medellin | Family Medicine | 228 Saint George St, Gonzales, TX 78629-3910 | 2005-08-11 |
| 1235785205 | Ogechi Anthonia Obiakor | Dentist | 228 Saint George St, Gonzales, TX 78629-3910 | 2019-08-14 |
| 1356891410 | Haley Lynn Pirkle | Counselor | 228 Saint George St, Gonzales, TX 78629-3910 | 2016-10-12 |
| 1902211923 | Chelsea Allison Padgett | Dentist | 228 Saint George St, Gonzales, TX 78629-3910 | 2014-06-28 |
| 1558789966 | Jill Ashley Elliott | Physician Assistant | 228 Saint George St, Gonzales, TX 78629-3910 | 2014-04-02 |
| 1770924961 | Gabriel Gallardo | Counselor | 228 Saint George St, Gonzales, TX 78629-3910 | 2013-07-16 |
| 1407197114 | Kelly Gibson | Physician Assistant | 228 Saint George St, Gonzales, TX 78629-3910 | 2013-03-05 |
| 1164776548 | Katherine D Paterson | Nurse Practitioner | 228 Saint George St, Gonzales, TX 78629-3910 | 2012-11-06 |
| 1740579853 | Courtney Lauren Panus | Licensed Vocational Nurse | 228 Saint George St, Gonzales, TX 78629-3910 | 2011-03-30 |
| 1457679821 | Rebecca Vela | Social Worker | 228 Saint George St, Gonzales, TX 78629-3910 | 2010-05-11 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265032072 | Bruce Franklin Blackwell | Pharmacist | 1114 East Sarah Dewitt Drive, Gonzales, TX 78629 | 2020-10-30 |
| 1790327765 | Gonzales County Emergency Services District 1 | Ambulance | 305 Qualls Street, Gonzales, TX 78629 | 2019-10-11 |
| 1831663400 | Caitlin Walker | Clinic/Center | 1300 Captain Albert Martin Trail, Gonzales, TX 78629 | 2019-01-17 |
| 1497251698 | Vaz Urgent Care Clinic, Pa | Clinic/Center | 1003 N Sarah Dewitt Drive, Gonzales, TX 78629 | 2018-04-05 |
| 1104348762 | Jeremiah Berryhill | Specialist/Technologist | 1711 E Sarah Dewitt Dr., Gonzales, TX 78629 | 2017-07-14 |
| 1073912861 | Gonzales County Senior Citizens Association, Inc | Home Delivered Meals | 818 Seydler Street, Gonzales, TX 78629 | 2014-08-18 |
| 1932544517 | Familylink Treatment Services | Counselor | 13326 Highway North 183, Gonzales, TX 78629 | 2013-05-08 |
| 1598035651 | H-e-b, Lp | Clinical Medical Laboratory | 1841 Church St., Gonzales, TX 78629 | 2012-01-06 |
| 1942441159 | Rebecca P. Bohach | Licensed Vocational Nurse | 228 St. George, Community Health Centers of South Central Texas, Inc, Gonzales, TX 78629 | 2009-03-18 |
| 1376763631 | Gonzales Isd | Local Education Agency (LEA) | 535 Fair St., Gonzales, TX 78629 | 2007-04-27 |
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| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467914481 | Hajar Nomura Sakhi | Physician Assistant | 850 5th St, Gonzales, CA 93926-9491 | 2019-04-01 |
| 1407197114 | Kelly Gibson | Physician Assistant | 228 Saint George St, Gonzales, TX 78629-3910 | 2013-03-05 |
| 1396992079 | Stephanie Jasik | Physician Assistant | 1110 N Sarah Dewitt Dr, Gonzales, TX 78629-3311 | 2008-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831704576 | Leila Olive Adell | Physician Assistant | 1221 S Congress Ave Apt 331, Austin, TX 78704-2461 | 2020-09-10 |
| 1619591864 | Today Telemedicine Pllc | Physician Assistant | 404 Oxford St Apt 2219, Houston, TX 77007-2679 | 2020-06-03 |
| 1497384168 | Gregory C Etienne | Physician Assistant | 7400 N 4th St, Mcallen, TX 78504-1859 | 2020-04-05 |
| 1689202475 | Theodore Inthaphom | Physician Assistant | 25222 Northwest Fwy Apt 349, Cypress, TX 77429-1065 | 2020-03-29 |
| 1740816982 | Alyssa Conrad | Physician Assistant | 4818 Star Jasmine Dr, Austin, TX 78723-6059 | 2020-03-19 |
| 1114558335 | Erin Lynn Brown | Physician Assistant | 1504 Taub Loop Houston, Houston, TX 77030 | 2020-01-27 |
| 1245870930 | Jessica Grimaldo | Physician Assistant | 1200 Brooklyn Ave Ste 230, San Antonio, TX 78212-0010 | 2020-01-09 |
| 1730728528 | Holli Marie Beard | Physician Assistant | 2625 Scripture St Ste 101, Denton, TX 76201-2304 | 2019-12-27 |
| 1477191237 | Ronald Edwin Brown | Physician Assistant | 1427 Cypress Point Dr, Gunter, TX 75058-3201 | 2019-12-11 |
| 1053957910 | Rossalya Aracely Granda Gutierrez | Physician Assistant | 4150 N Collins St, Arlington, TX 76005-4547 | 2019-11-25 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.