Healthcare Provider Details

I. General information

NPI: 1376119222
Provider Name (Legal Business Name): KEVREONNA MARIE HYPOLITE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 FANNIN ST STE 370
HOUSTON TX
77030-3004
US

IV. Provider business mailing address

18200 KATY FWY
HOUSTON TX
77094-1285
US

V. Phone/Fax

Practice location:
  • Phone: 713-500-7796
  • Fax:
Mailing address:
  • Phone: 601-549-2451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14376
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberPA14376
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: