Shalla M Proctor, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA08411 Issued in TX

Practice address

2655 W Baker Rd
Baytown, TX 77521-2206

Phone

(281) 425-9205

Fax

(281) 422-9408

NPI assigned

Jul 11, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Shalla M Khalil Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clear Lake Family Physicians, LLP

  • Primary Care Clinic/Center
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  • NPI 1821054826
  NPD
• Utmb Faculty Group Practice

  • General Practice Physician
  • Galveston, TX
  • NPI 1942241146
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407801600000",
    "number": "1194759357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2655 W BAKER RD",
            "city": "BAYTOWN",
            "state": "TX",
            "postal_code": "775212206",
            "telephone_number": "281-425-9205",
            "fax_number": "281-422-9408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2655 W BAKER RD",
            "city": "BAYTOWN",
            "state": "TX",
            "postal_code": "775212206",
            "telephone_number": "281-425-9205",
            "fax_number": "281-422-9408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "SHALLA",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2014-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-01112",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA08411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHALLA",
            "last_name": "KHALIL",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Premiercare Family Clinic
• Priscilla Marie Presson, FNP-C
• Charles Priewe, DC
• Prima Seraph (Cameo Medical Supplies)
• Donna Prince
• Progressive Anesthesia Services, PLLC
• Progressive Multi-Specialty Group, PLLC
• Progressive Urgent Care, LLC
• Provectus Medical Inc
• Providence ER of Baytown PLLC (Cypress Creek ER)

• Physician Assistant in Baytown, TX
• Providers in Baytown, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.