Provider Demographics
NPI:1851901250
Name:WEBSTER, MICHELE
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6414 ST LEONARD DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-7847
Mailing Address - Country:US
Mailing Address - Phone:702-885-2673
Mailing Address - Fax:
Practice Address - Street 1:2709 MEADOW ISLE LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3215
Practice Address - Country:US
Practice Address - Phone:214-298-3887
Practice Address - Fax:817-977-0201
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1063804300Medicaid