MEDICARE: MISS LEAH MICHELLE MEADOR CRNA

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	163WC0200X	Critical Care Medicine Registered Nurse	960953	TX
2	207L00000X	Anesthesiology Physician	1204498	TX
3	367500000X	Certified Registered Nurse Anesthetist	1204498	TX

General Provider Information

NPI Number	:	1093504276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LEAH MICHELLE MEADOR CRNA

Provider Business Mailing Address
First Line	:	3131 TIMMONS LN APT 1228
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-6076
Country	:	US
Telephone Number	:	281-682-7417
Fax Number	:

Provider Business Practice Location Address
First Line	:	3131 TIMMONS LN APT 1228
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-6076
Country	:	US
Telephone Number	:	281-682-7417
Fax Number	:

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

Provider Enumeration Date	:	05/05/2025
Last Update Date	:	08/19/2025

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