Healthcare Provider Details

I. General information

NPI: 1114335775
Provider Name (Legal Business Name): MILLENNIUM PHYSICIANS ASSOCIATON, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22710 PROFESSIONAL DR SUITE 203
KINGWOOD TX
77339-6008
US

IV. Provider business mailing address

22710 PROFESSIONAL DR SUITE 101
KINGWOOD TX
77339-6008
US

V. Phone/Fax

Practice location:
  • Phone: 281-312-8530
  • Fax: 281-312-8532
Mailing address:
  • Phone: 281-312-8560
  • Fax: 281-312-8561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP125859
License Number StateTX

VIII. Authorized Official

Name: MELODY A MOLLOY
Title or Position: C.O.O.
Credential: R.N.
Phone: 281-358-2850