Melissa R Mignogna, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

36831 Issued in TX

Practice address

111 Vision Park Blvd
Suite 250
Shenandoah, TX 77384-3002

Phone

(281) 528-4226

Fax

(281) 419-0921

NPI assigned

Feb 22, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Melissa R Jackson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 12, 2024 through Feb 12, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434326400000",
    "number": "1124297270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6541 CASCADE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767124302",
            "telephone_number": "405-612-8574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 VISION PARK BLVD",
            "address_2": "SUITE 250",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773843002",
            "telephone_number": "281-528-4226",
            "fax_number": "281-419-0921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIGNOGNA",
        "first_name": "MELISSA",
        "middle_name": "R",
        "name_prefix": "Prof.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-22",
        "last_updated": "2015-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "36831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "JACKSON",
            "middle_name": "R",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michael Ray Gerdts LTD
• Lilly Michael, PA-C
• Michelle a Hanes Mdpa
• Michelle M. Mulder, M.D.P.a.
• Shelby Mickey
• Danielle Renee Milanowski, FNP-C
• Angela Miles, PA-C
• Aaron M. Miller, M.D.
• Yoann Henry Millet, M.D.
• Kaley Mims, CAA

• Psychologist in Shenandoah, TX
• Providers in Shenandoah, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.