Basic Information
| Provider Information | |||||||||
| NPI: | 1548630205 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELEON | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | BRIGHTON | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN, FNP-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BECKLEY | ||||||||
| OtherFirstName: | MICHELLE | ||||||||
| OtherMiddleName: | BRIGHTON | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | APRN, FNP-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1567 MAIN STREET #100 | ||||||||
| Address2: | |||||||||
| City: | BUDA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123514405 | ||||||||
| FaxNumber: | 5122952068 | ||||||||
| Practice Location | |||||||||
| Address1: | 1567 MAIN STREET #100 | ||||||||
| Address2: | |||||||||
| City: | BUDA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123514405 | ||||||||
| FaxNumber: | 5122952068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2015 | ||||||||
| LastUpdateDate: | 01/29/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP129214 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | AP129214 | 01 | TX | APRN LICENSE NO. | OTHER | 775049 | 01 | TX | RN LICENSE | OTHER |