Provider Demographics
NPI:1003522525
Name:MYERS, ADAM NICHOLAS
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:NICHOLAS
Last Name:MYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 WILLOWBEND DR
Mailing Address - Street 2:
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-2262
Mailing Address - Country:US
Mailing Address - Phone:817-879-3996
Mailing Address - Fax:
Practice Address - Street 1:403 WILLOWBEND DR
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-2262
Practice Address - Country:US
Practice Address - Phone:817-879-3996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61405206367500000X
TXAP1188082367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered