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General NPI Number Information
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NPI Number | 1215197694
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Entity Type | Individual
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Provider Name | MELISSA K NICHOLAS PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 3450 FM 1960 WEST
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City | HOUSTON
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State | TX
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Zip | 76042-2435
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Country | US
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Telephone | 281-444-1738
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Fax | 281-444-3084
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Provider Business Mailing Address
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Address Line | 1700 WEST LOOP SOUTH STE 400B
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City | HOUSTON
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State | TX
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Zip | 77027-3005
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Country | US
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Telephone | 713-277-2222
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Fax | 210-703-0934
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA06018
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License Number State | TX
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