MEDICARE: KELLY MICHELLE BROWN 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	363AS0400X	Surgical Physician Assistant	PA08669	TX

General Provider Information

NPI Number	:	1952397291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY MICHELLE BROWN PA-C

Provider Business Mailing Address
First Line	:	6431 FANNIN ST # 3.286
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:	713-242-2366
Fax Number	:

Provider Business Practice Location Address
First Line	:	6410 FANNIN ST STE 350
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3004
Country	:	US
Telephone Number	:	713-242-2366
Fax Number	:

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	08/09/2022

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