Provider Demographics
NPI:1598327942
Name:MCCOLLOM, NELLIE ELIZABETH (MS, RN, FNP-C, CHPPN)
Entity Type:Individual
Prefix:
First Name:NELLIE
Middle Name:ELIZABETH
Last Name:MCCOLLOM
Suffix:
Gender:F
Credentials:MS, RN, FNP-C, CHPPN
Other - Prefix:
Other - First Name:NELLIE
Other - Middle Name:ELIZABETH
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:902 FROSTWOOD DR STE 288
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2403
Mailing Address - Country:US
Mailing Address - Phone:713-501-8704
Mailing Address - Fax:713-932-5680
Practice Address - Street 1:902 FROSTWOOD DR STE 288
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2403
Practice Address - Country:US
Practice Address - Phone:713-501-8704
Practice Address - Fax:713-932-5680
Is Sole Proprietor?:No
Enumeration Date:2019-07-07
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily