Provider Demographics
NPI:1053674853
Name:OSADA, MELISSA PORTER (PMHNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:PORTER
Last Name:OSADA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 ROGERS RD APT 515
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4591
Mailing Address - Country:US
Mailing Address - Phone:210-551-6242
Mailing Address - Fax:210-731-8678
Practice Address - Street 1:358 LANDA ST STE 300
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-5451
Practice Address - Country:US
Practice Address - Phone:210-551-6242
Practice Address - Fax:210-731-8678
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX740517364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health