Provider Demographics
NPI:1184776775
Name:COTHREN, TIFFANY A (AA)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:COTHREN
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:A
Other - Last Name:LEWIS-ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:1500 CITYWEST BLVD
Practice Address - Street 2:STE. 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2300
Practice Address - Country:US
Practice Address - Phone:713-620-4000
Practice Address - Fax:713-458-4229
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX705367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00292002OtherRAILROAD MEDICARE
TXP01466089OtherRR MEDICARE
TX348104601Medicaid
TX8G2606Medicare PIN
TXP01466089OtherRR MEDICARE