Provider Demographics
NPI:1770500217
Name:ECKHARDT, PATRICIA (C-FNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:ECKHARDT
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SOUTHPORT LN
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-2920
Mailing Address - Country:US
Mailing Address - Phone:281-334-0539
Mailing Address - Fax:
Practice Address - Street 1:9522 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7724
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX649102363LF0000X, 363L00000X
CA363151363L00000X
TXAP108665363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041479901Medicaid
TX041479902Medicaid
TX041479902Medicaid
TX82N544Medicare PIN