MEDICARE: MELISSA ERIN WILKES REQUENEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	P2400	TX

General Provider Information

NPI Number	:	1982829719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ERIN WILKES REQUENEZ M.D.

Provider Business Mailing Address
First Line	:	9722 GASTON RD STE 150-277
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-7941
Country	:	US
Telephone Number	:	713-249-9411
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 PARK GROVE DR
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-1571
Country	:	US
Telephone Number	:	413-862-2563
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	05/14/2024

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