Provider Demographics
NPI:1457820458
Name:MATTHEWS, MELANIE MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:MARIE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:MARIE
Other - Last Name:FORSYTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:104 HIDDEN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-2169
Mailing Address - Country:US
Mailing Address - Phone:281-948-6056
Mailing Address - Fax:
Practice Address - Street 1:1607 HWY 71 E STE D
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-2033
Practice Address - Country:US
Practice Address - Phone:512-856-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12280363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant