Basic Information
| Provider Information | |||||||||
| NPI: | 1215129135 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARTHOLOMEW | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | REEVES | ||||||||
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| Credential: | PAC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | REEVES | ||||||||
| OtherFirstName: | AMY | ||||||||
| OtherMiddleName: | REBECCA | ||||||||
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| OtherCredential: | PAC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1425 RUTLAND ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770084139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138395165 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6621 FANNIN ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328241000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2007 | ||||||||
| LastUpdateDate: | 05/08/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA06317 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | PA06317 | 01 | TX | TEXAS MEDICAL BOARD | OTHER |