Provider Demographics
NPI:1639205545
Name:DONNELLY, ELLEN (PMH- NP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:PMH- NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9525 KATY FWY
Mailing Address - Street 2:SUITE 312
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1407
Mailing Address - Country:US
Mailing Address - Phone:713-463-9449
Mailing Address - Fax:716-463-7181
Practice Address - Street 1:9525 KATY FWY
Practice Address - Street 2:SUITE 312
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1407
Practice Address - Country:US
Practice Address - Phone:713-463-9449
Practice Address - Fax:716-463-7181
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX654876363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N7077OtherBLUE CROSS BLUE SHIELD
TX10041922OtherAMERIGROUP
TX8N7077OtherBLUE CROSS BLUE SHIELD