Mangon, Tanisha Lavelle

Mangon, Tanisha Lavelle is an individual health care provider with primary practice located at 24275 Katy Fwy Ste 400 , Katy TX 77494-7267. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as her primary health care specialty. Mangon, Tanisha Lavelle can be contacted via phone (346) 387-7171.

Contact Information

Primary practice address
24275 Katy Fwy Ste 400 Katy TX 77494-7267
Phone: (346) 387-7171
Fax: (844) 703-5305
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 709892 Texas

Profile Details

NPI number 1770896953
LBN Legal business name Mangon, Tanisha Lavelle
Credentials MSN, NP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 16th, 2010
Last updated Mar 17th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770896953 NPPES
Texas MEDICAID 215538407

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