Provider Demographics
NPI:1033321781
Name:ROBERTSON, AMANDA R (PA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7900 FANNIN ST
Mailing Address - Street 2:3012
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2934
Mailing Address - Country:US
Mailing Address - Phone:713-512-7000
Mailing Address - Fax:713-512-7027
Practice Address - Street 1:250 BLOSSOM ST
Practice Address - Street 2:STE. 350
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4204
Practice Address - Country:US
Practice Address - Phone:713-512-7000
Practice Address - Fax:713-512-7027
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2009-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA04621363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical