Provider Demographics
NPI:1568442713
Name:PATTERSON, TIFFANY E (PA-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:E
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 200993
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-0993
Mailing Address - Country:US
Mailing Address - Phone:281-784-1111
Mailing Address - Fax:281-784-1555
Practice Address - Street 1:13111 EAST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5820
Practice Address - Country:US
Practice Address - Phone:713-393-2000
Practice Address - Fax:713-393-2714
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02736363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181532601Medicaid
TX87N793OtherBC/BS PROVIDER NUMBER
TX970015529Medicare PIN
TX181532601Medicaid
TX86N911Medicare PIN
TX87N793OtherBC/BS PROVIDER NUMBER