Provider Demographics
NPI:1376094193
Name:DRIVER, DEMORI (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DEMORI
Middle Name:
Last Name:DRIVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W SAM HOUSTON PKWY S STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-1914
Mailing Address - Country:US
Mailing Address - Phone:713-462-6565
Mailing Address - Fax:
Practice Address - Street 1:19333 CLAY RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-4001
Practice Address - Country:US
Practice Address - Phone:713-462-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2017-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10895363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical