Provider Demographics
NPI:1013900091
Name:ROCKETT, ANDREA K (DPM)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:K
Last Name:ROCKETT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 BAY AREA BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2538
Mailing Address - Country:US
Mailing Address - Phone:281-488-3237
Mailing Address - Fax:281-488-4218
Practice Address - Street 1:1234 BAY AREA BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2538
Practice Address - Country:US
Practice Address - Phone:281-488-3237
Practice Address - Fax:281-488-4218
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1392213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101176903Medicaid
TX101176903Medicaid
TX8432N0Medicare ID - Type Unspecified