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General NPI Number Information
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NPI Number | 1235694209
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Entity Type | Individual
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Provider Name | KAELIN ELIZABETH MEAD PA
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Gender | Female
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 1504 BEN TAUB LOOP
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City | HOUSTON
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State | TX
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Zip | 77030
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Country | US
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Telephone | 713-873-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 6722 E 35TH ST
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City | YUMA
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State | AZ
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Zip | 85365-8206
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Country | US
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Telephone |
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA13167
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 8270
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License Number State | AZ
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