Provider Demographics
NPI:1477869972
Name:NORTON, NICOLE ANGELIQUE (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANGELIQUE
Last Name:NORTON
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 1:14811 SAINT MARYS LN STE 270
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2908
Mailing Address - Country:US
Mailing Address - Phone:281-497-3500
Mailing Address - Fax:281-497-3512
Practice Address - Street 1:14811 SAINT MARYS LN STE 270
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2908
Practice Address - Country:US
Practice Address - Phone:281-497-3500
Practice Address - Fax:281-497-3512
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06816363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J21AOtherGROUP MEDICARE NUMBER
TX094010801OtherGROUP MEDICAID NUMBER