Provider Demographics
NPI:1376119222
Name:HYPOLITE, KEVREONNA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KEVREONNA
Middle Name:MARIE
Last Name:HYPOLITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18200 KATY FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1285
Mailing Address - Country:US
Mailing Address - Phone:601-549-2451
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST STE 370
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3004
Practice Address - Country:US
Practice Address - Phone:713-500-7796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14376363A00000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant