Provider Demographics
NPI:1710202569
Name:SHELLY, KATHY (PA)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:SHELLY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 1701, ATT: RENEE BROWN
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-798-8291
Mailing Address - Fax:713-798-5294
Practice Address - Street 1:6701 FANNIN ST
Practice Address - Street 2:SUITE 540
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2316
Practice Address - Country:US
Practice Address - Phone:832-822-3250
Practice Address - Fax:832-825-1622
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA 00264363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical