Active NPI
Mandy Moreno Micheaux, PA-C
- Neurology Physician
- Sherman, TX
National Provider Identifier
1881741346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- PA04403
- Practice address
- 321 N Highland Ave Ste 200
Sherman, TX 75092-7371 - Phone
- (903) 893-5141
- NPI assigned
- Jan 5, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | PA04403 | TX | Primary |
| Medical Physician Assistant | 363AM0700X | PA04403 | TX |
Addresses
Primary practice location
321 N Highland Ave Ste 200
Sherman, TX 75092-7371
Mailing address
321 N Highland Ave Ste 200
Sherman, TX 75092-7371
Phone (903) 893-5141
Other practice location 1
2609 Sagebrush Dr Ste 101
Flower Mound, TX 75028-4670
Phone (972) 539-4875
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881741346 | Other | TX | NPI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA04403 | TX | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667779200000",
"number": "1881741346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "321 N HIGHLAND AVE STE 200",
"city": "SHERMAN",
"state": "TX",
"postal_code": "750927371",
"telephone_number": "903-893-5141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "321 N HIGHLAND AVE STE 200",
"city": "SHERMAN",
"state": "TX",
"postal_code": "750927371",
"telephone_number": "903-893-5141"
}
],
"practiceLocations": [
{
"address_1": "2609 Sagebrush Dr Ste 101",
"address_purpose": "LOCATION",
"city": "Flower Mound",
"state": "TX",
"postal_code": "750284670",
"country_code": "US",
"telephone_number": "972-539-4875",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MICHEAUX",
"first_name": "MANDY",
"middle_name": "MORENO",
"name_prefix": "Prof.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-05",
"last_updated": "2022-11-07",
"certification_date": "2022-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "TX",
"license": "PA04403",
"primary": true
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TX",
"license": "PA04403",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1881741346",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sherman, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.