Individual
MRS. MICHELLE AYESHA MACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
8715 W HIGHWAY 71 APT 4109, AUSTIN, TX 78735-0036
(410) 615-8566
Mailing address
8715 W HIGHWAY 71 APT 4109, AUSTIN, TX 78735-0036
(141) 061-5856
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP134596
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
R170142
MD
Other
Enumeration date
08/27/2013
Last updated
10/04/2023
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