Provider Demographics
NPI:1114806031
Name:MADSEN, ELLE (PA-C)
Entity type:Individual
Prefix:
First Name:ELLE
Middle Name:
Last Name:MADSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 HOLLY HALL ST APT 506
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4176
Mailing Address - Country:US
Mailing Address - Phone:801-917-9778
Mailing Address - Fax:
Practice Address - Street 1:2800 KIRBY DR STE B212
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-1742
Practice Address - Country:US
Practice Address - Phone:713-559-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA19255363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant