Provider Demographics
NPI:1700333481
Name:PICKENS, LOURDES (NP)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:PICKENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18220 STATE HIGHWAY 249
Mailing Address - Street 2:SUITE 249
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4347
Mailing Address - Country:US
Mailing Address - Phone:281-737-8300
Mailing Address - Fax:281-737-1335
Practice Address - Street 1:18220 STATE HIGHWAY 249
Practice Address - Street 2:SUITE 249
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4347
Practice Address - Country:US
Practice Address - Phone:281-737-8300
Practice Address - Fax:281-737-1335
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX704557363LA2100X
TXAP132154363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8868NZOtherBCBS
TX548335ZSWDMedicare UPIN