Healthcare Provider Details

I. General information

NPI: 1407655699
Provider Name (Legal Business Name): MICHELYN GRACE VALLE DELOS REYES APRN-CNP, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BLOSSOM ST
WEBSTER TX
77598-4204
US

IV. Provider business mailing address

1412 CHAPPARAL XING
LEAGUE CITY TX
77573-9062
US

V. Phone/Fax

Practice location:
  • Phone: 832-632-6500
  • Fax:
Mailing address:
  • Phone: 619-259-3445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1192383
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: