Provider Demographics
NPI:1134792070
Name:TIEN, PAUL (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:TIEN
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4706 LAURELDALE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-8500
Mailing Address - Country:US
Mailing Address - Phone:832-406-8767
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN ST STE 1554
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2714
Practice Address - Country:US
Practice Address - Phone:713-796-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1047274363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care