NPIMap

Individual provider Active NPI

Nichole Ann Tayeh Doussan, PA-C

  • Physician Assistant
  • The Woodlands, TX
National Provider Identifier
1770966384
Registry record updated Jan 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA12941 Issued in TX
Practice address
17200 St Lukes Way
The Woodlands, TX 77384-8007
Phone
(936) 266-2000
NPI assigned
Jun 30, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.200836 LA
Physician Assistant 363A00000X PA12941 TX Primary

Addresses

Primary practice location

17200 St Lukes Way
The Woodlands, TX 77384-8007

Mailing address

5514 Olympiad Dr
Houston, TX 77041-5519
Phone (214) 538-5435

Other practice location 1

2700 Napoleon Ave
New Orleans, LA 70115-6914
Phone (504) 899-9311

Other identifiers 2

IdentifierTypeStateIssuer
05028232MedicaidMS
2400134MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150914002501 LA Practitioner - Physician Assistant 4183931843 Reassigns benefits to 7 organizations
I20211116001369 TX Practitioner - Physician Assistant 4183931843 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ochsner Clinic LLC CurrentSince Sep 14, 2015 Accepting new patients
Ochsner Clinic LLC CurrentSince Sep 14, 2015 Accepting new patients
Ochsner Clinic LLC Past Accepting new patients

Locations

180 W Esplanade Ave
Kenner, LA 70065
Phone (504) 464-8284

1057 Paul Maillard Rd
Luling, LA 70070
Phone (985) 785-3655

1514 Jefferson Hwy
New Orleans, LA 70121

2700 Napoleon Ave
New Orleans, LA 70115
Phone (504) 842-3650

100 Medical Center Dr
Slidell, LA 70461
Phone (504) 392-3131

1001 Gause Blvd
Slidell, LA 70458
Phone (985) 280-2200

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1435622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673308800000",
    "number": "1770966384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5514 OLYMPIAD DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770415519",
            "telephone_number": "214-538-5435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17200 ST LUKES WAY",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "773848007",
            "telephone_number": "936-266-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2700 Napoleon Ave",
            "address_purpose": "LOCATION",
            "city": "New Orleans",
            "state": "LA",
            "postal_code": "701156914",
            "country_code": "US",
            "telephone_number": "504-899-9311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUSSAN",
        "first_name": "NICHOLE",
        "middle_name": "ANN TAYEH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-30",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "PA.200836",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA12941",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05028232",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2400134",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in The Woodlands, TX

Sources for this page

Verify at the official NPI Registry.