Provider Demographics
NPI:1902960743
Name:MCTAMANY-ALLEN, PATRICIA (FNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MCTAMANY-ALLEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 DELANO ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-3284
Mailing Address - Country:US
Mailing Address - Phone:713-333-1336
Mailing Address - Fax:713-333-1338
Practice Address - Street 1:3315 DELANO ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-3284
Practice Address - Country:US
Practice Address - Phone:713-333-1336
Practice Address - Fax:713-333-1338
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX528864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
742997011OtherTAX ID #
TX149551701Medicaid
742997011OtherTAX ID #