Provider Demographics
NPI:1346797610
Name:KELLY, HANNAH ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:ELIZABETH
Last Name:KELLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:ELIZABETH
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:16605 SOUTHWEST FREEWAY
Mailing Address - Street 2:MOB 3, SUITE 450
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479
Mailing Address - Country:US
Mailing Address - Phone:281-275-0880
Mailing Address - Fax:281-275-0861
Practice Address - Street 1:16605 SOUTHWEST FREEWAY
Practice Address - Street 2:MEDICAL BUILDING 3, SUITE 450
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-275-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10745363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX385359001Medicaid
TX385359002Medicaid