Provider Demographics
NPI:1952644171
Name:SCOTT, KELLIE ANN (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:ANN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N POST OAK LN
Mailing Address - Street 2:SUITE 420
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-7715
Mailing Address - Country:US
Mailing Address - Phone:713-680-2611
Mailing Address - Fax:713-680-2303
Practice Address - Street 1:123 N POST OAK LN
Practice Address - Street 2:SUITE 420
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-7715
Practice Address - Country:US
Practice Address - Phone:713-680-2611
Practice Address - Fax:713-680-2303
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07727363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant