Provider Demographics
NPI:1215197694
Name:NICHOLAS, MELISSA K (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:1700 WEST LOOP SOUTH
Mailing Address - Street 2:STE 400B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-3005
Mailing Address - Country:US
Mailing Address - Phone:713-277-2222
Mailing Address - Fax:210-703-0934
Practice Address - Street 1:3450 FM 1960 WEST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:76042-2435
Practice Address - Country:US
Practice Address - Phone:281-444-1738
Practice Address - Fax:281-444-3084
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2009-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06018363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
8L16626Medicare PIN