Basic Information
| Provider Information | |||||||||
| NPI: | 1871061804 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASSARIAN | ||||||||
| FirstName: | KELSEY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7401 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770304509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137992300 | ||||||||
| FaxNumber: | 7137943395 | ||||||||
| Practice Location | |||||||||
| Address1: | 2635 W BAKER RD | ||||||||
| Address2: | |||||||||
| City: | BAYTOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775212206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818378550 | ||||||||
| FaxNumber: | 2818378709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2018 | ||||||||
| LastUpdateDate: | 11/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA12331 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.