Provider Demographics
NPI:1003277310
Name:IRVIN, MELODIE (PA)
Entity Type:Individual
Prefix:
First Name:MELODIE
Middle Name:
Last Name:IRVIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7474 S KIRKWOOD RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-3307
Mailing Address - Country:US
Mailing Address - Phone:281-564-5500
Mailing Address - Fax:281-564-5502
Practice Address - Street 1:7474 S KIRKWOOD RD
Practice Address - Street 2:SUITE 206
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-3307
Practice Address - Country:US
Practice Address - Phone:281-564-5500
Practice Address - Fax:281-564-5502
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA00855363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant