Provider Demographics
NPI:1215129135
Name:BARTHOLOMEW, AMY REEVES (PAC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:REEVES
Last Name:BARTHOLOMEW
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:REBECCA
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1425 RUTLAND ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-4139
Mailing Address - Country:US
Mailing Address - Phone:713-839-5165
Mailing Address - Fax:
Practice Address - Street 1:6621 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2303
Practice Address - Country:US
Practice Address - Phone:832-824-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06317363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA06317OtherTEXAS MEDICAL BOARD