1184179574 NPI number — MRS. TAMITHA ELAINE MACKEY FNP

Table of content: MRS. TAMITHA ELAINE MACKEY FNP (NPI 1184179574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184179574 NPI number — MRS. TAMITHA ELAINE MACKEY FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACKEY
Provider First Name:
TAMITHA
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184179574
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21309 FOSTER RD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77388-4209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-587-1700
Provider Business Mailing Address Fax Number:
281-586-3808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18419 VANHORN CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77379-5153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-819-3828
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SF0001X , with the licence number:  746221 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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