Provider Demographics
NPI:1467487496
Name:MCILHENNY, SUSAN GAIL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:GAIL
Last Name:MCILHENNY
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 1:9615 SUMMER RUN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-5395
Mailing Address - Country:US
Mailing Address - Phone:281-387-8148
Mailing Address - Fax:
Practice Address - Street 1:367 GREENS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-1903
Practice Address - Country:US
Practice Address - Phone:281-875-1800
Practice Address - Fax:281-875-1801
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00266363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant