MEDICARE: MELISSA K NICHOLAS 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	PA06018	TX

General Provider Information

NPI Number	:	1215197694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA K NICHOLAS PA-C

Provider Business Mailing Address
First Line	:	1700 WEST LOOP SOUTH
Second Line	:	STE 400B
City	:	HOUSTON
State	:	TX
Zip	:	77027-3005
Country	:	US
Telephone Number	:	713-277-2222
Fax Number	:	210-703-0934

Provider Business Practice Location Address
First Line	:	3450 FM 1960 WEST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	76042-2435
Country	:	US
Telephone Number	:	281-444-1738
Fax Number	:	281-444-3084

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

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	09/22/2009

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