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:
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 1:13440 UNIVERSITY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4907
Mailing Address - Country:US
Mailing Address - Phone:832-500-8135
Mailing Address - Fax:833-521-2186
Practice Address - Street 1:13440 UNIVERSITY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4907
Practice Address - Country:US
Practice Address - Phone:832-500-8135
Practice Address - Fax:833-521-2186
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010964363A00000X
TXPA17711363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant