Provider Demographics
NPI:1003291386
Name:HENNEGAN, TARIN DOUBT (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TARIN
Middle Name:DOUBT
Last Name:HENNEGAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TARIN
Other - Middle Name:ANNE
Other - Last Name:DOUBT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
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:2015-07-28
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11441363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2400371Medicaid
MS00571821Medicaid
TX380310802Medicaid
TX8JD383OtherBCBS
TX380310801Medicaid