Provider Demographics
NPI:1710633029
Name:KHOURY, OLIVIA MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:MARIE
Last Name:KHOURY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:OLIVIA
Other - Middle Name:MARIE
Other - Last Name:GHANNAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OLIVIA MARIE GHANNAM
Mailing Address - Street 1:P O BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4000
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17711363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant