Provider Demographics
NPI:1225326473
Name:MULLMAN, KELLY DRESSER (PA)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:DRESSER
Last Name:MULLMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 GESSNER RD STE 750
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2574
Mailing Address - Country:US
Mailing Address - Phone:713-333-6900
Mailing Address - Fax:713-333-6919
Practice Address - Street 1:915 GESSNER RD STE 750
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2574
Practice Address - Country:US
Practice Address - Phone:713-333-6900
Practice Address - Fax:713-333-6919
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2098363A00000X
TXPA07158363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1225326473OtherBLUE CROSS BLUE SHIELD
TX284127201Medicaid
TX284127201Medicaid
TXTXB135183Medicare PIN