Provider Demographics
NPI:1144270232
Name:COMBS, MICHELLE LYNN (CRNA)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LYNN
Last Name:COMBS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:WILT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:414 CLAY RD
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276-6907
Mailing Address - Country:US
Mailing Address - Phone:681-867-9060
Mailing Address - Fax:
Practice Address - Street 1:6225 N STATE HIGHWAY 161 STE 200
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2241
Practice Address - Country:US
Practice Address - Phone:214-687-0975
Practice Address - Fax:214-687-9319
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR76081367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1223Medicaid
SCQ33368Medicare UPIN