Provider Demographics
NPI:1205931219
Name:KLIMISCH, TRACY LEE (PA-C)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:KLIMISCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 VISTA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2160
Mailing Address - Country:US
Mailing Address - Phone:713-844-2400
Mailing Address - Fax:713-844-2480
Practice Address - Street 1:3801 VISTA RD STE 100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2160
Practice Address - Country:US
Practice Address - Phone:713-844-2400
Practice Address - Fax:713-844-2470
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02034363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA02034OtherPA-C LICENSE