Provider Demographics
NPI:1811235674
Name:PREMIER PEDIATRICS OF HOUSTON
Entity Type:Organization
Organization Name:PREMIER PEDIATRICS OF HOUSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMECKA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP, DNP
Authorized Official - Phone:281-979-2112
Mailing Address - Street 1:2128 SPEARS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-1320
Mailing Address - Country:US
Mailing Address - Phone:281-979-2112
Mailing Address - Fax:281-884-3558
Practice Address - Street 1:2128 SPEARS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-1320
Practice Address - Country:US
Practice Address - Phone:281-979-2112
Practice Address - Fax:281-884-3558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20030764363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3117269-03OtherTX HEALTH STEPS
TX3117269-01Medicaid
TX3117269-02OtherCSHCN