MEDICARE: KELSI ANN VILARDO PA-C

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	363AM0700X	Medical Physician Assistant	PA13776	TX

General Provider Information

NPI Number	:	1407367881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSI ANN VILARDO PA-C

Provider Business Mailing Address
First Line	:	2204 AUSTIN ST STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77002-8912
Country	:	US
Telephone Number	:	713-640-5477
Fax Number	:	713-640-5872

Provider Business Practice Location Address
First Line	:	2204 AUSTIN ST STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77002-8912
Country	:	US
Telephone Number	:	713-640-5477
Fax Number	:	713-640-5872

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

Provider Enumeration Date	:	10/12/2017
Last Update Date	:	05/06/2024

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Directions to “ KELSI ANN VILARDO PA-C” Practice Location

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