Provider Demographics
NPI:1073119467
Name:MCCARDELL, BECKY WOOTEN
Entity Type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:WOOTEN
Last Name:MCCARDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 FM 1960 RD W STE 400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4615
Mailing Address - Country:US
Mailing Address - Phone:800-477-0697
Mailing Address - Fax:877-421-9117
Practice Address - Street 1:4606 FM 1960 RD W STE 400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4615
Practice Address - Country:US
Practice Address - Phone:800-477-0697
Practice Address - Fax:877-421-9117
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty