Provider Demographics
NPI:1396159240
Name:TOUSSAINT, PIERRETTE (MD)
Entity type:Individual
Prefix:
First Name:PIERRETTE
Middle Name:
Last Name:TOUSSAINT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PIERRETTE
Other - Middle Name:
Other - Last Name:JEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1614 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4467
Mailing Address - Country:US
Mailing Address - Phone:954-446-4295
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 27066
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76127-0066
Practice Address - Country:US
Practice Address - Phone:817-782-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3062208D00000X
KSTW-00564208D00000X
FLTPME7027208D00000X
PR19004208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice