Individual
AUDREY C LIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6414 FANNIN ST STE G150, HOUSTON, TX 77030-1514
(713) 486-7515
Mailing address
6400 FANNIN ST STE 1700, HOUSTON, TX 77030-1526
(713) 486-6998
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA07450
TX
Other
Enumeration date
09/15/2011
Last updated
10/22/2018
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