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NPI Code Detail

MEDICARE: VANESSA LYNN ELLEDGE P.A.-C

MEDICARE: VANESSA LYNN ELLEDGE P.A.-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
1363A00000XPhysician AssistantPA04602TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA04602OTHERTXLICENSE

General Provider Information

NPI Number : 1467675454
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSA LYNN ELLEDGE P.A.-C
Provider Business Mailing Address
First Line : 22698 PROFESSIONAL DR STE 110
Second Line :
City : KINGWOOD
State : TX
Zip : 77339-5705
Country : US
Telephone Number : 281-312-8521
Fax Number :
Provider Business Practice Location Address
First Line : 22698 PROFESSIONAL DR STE 110
Second Line :
City : KINGWOOD
State : TX
Zip : 77339-5705
Country : US
Telephone Number : 281-312-8521
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2007
Last Update Date : 08/25/2025

Similar Medicare Providers

1215290499 — DR. NAZAR E MOHAMED SANOUSI MD
Practice Location Address:
22698 PROFESSIONAL DR STE 110
KINGWOOD, TX
77339-5705
Practice Phone: 281-312-8521
Practice Fax:
1942909312 — MRS. ADRIENNE ELISABETH TALLINA PA-C
Practice Location Address:
22698 PROFESSIONAL DR STE 110
KINGWOOD, TX
77339-5705
Practice Phone: 281-312-8521
Practice Fax:
1972319788 — LINA CHANG DAVISON
Practice Location Address:
22698 PROFESSIONAL DR STE 110
KINGWOOD, TX
77339-5705
Practice Phone: 346-305-5660
Practice Fax:
1811853799 — NATALIE SHEA JENNINGS
Practice Location Address:
601 ROCKMEAD DR STE 100
KINGWOOD, TX
77339-2107
Practice Phone: 281-955-2650
Practice Fax: 281-955-5875
1639023955 — BRIANNA SCHOONOVER CSFA
Practice Location Address:
24040 HIGHWAY 59 N
KINGWOOD, TX
77339-1500
Practice Phone: 936-441-1010
Practice Fax:
1821796939 — JOSE LUIS TOIRAC FAEZ FNP-C
Practice Location Address:
300 NORTHPARK DR
KINGWOOD, TX
77339-1672
Practice Phone: 281-310-8445
Practice Fax: 281-312-4641

Directions to “ VANESSA LYNN ELLEDGE P.A.-C” Practice Location

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