Provider Demographics
NPI:1609440254
Name:GONZALES, TIERNEY (PA-C)
Entity Type:Individual
Prefix:
First Name:TIERNEY
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TIERNEY
Other - Middle Name:
Other - Last Name:FICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9601 JONES RD STE 238
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4774
Mailing Address - Country:US
Mailing Address - Phone:281-469-2181
Mailing Address - Fax:
Practice Address - Street 1:9601 JONES RD STE 238
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4774
Practice Address - Country:US
Practice Address - Phone:281-469-2181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant