Provider Demographics
NPI:1679622294
Name:POWELL, TAMMIE WOLFF (PA-C)
Entity type:Individual
Prefix:
First Name:TAMMIE
Middle Name:WOLFF
Last Name:POWELL
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10740 N GESSNER RD
Mailing Address - Street 2:STE 310
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1240
Mailing Address - Country:US
Mailing Address - Phone:281-897-0416
Mailing Address - Fax:281-890-8908
Practice Address - Street 1:21216 NORTHWEST FWY
Practice Address - Street 2:STE 310
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4698
Practice Address - Country:US
Practice Address - Phone:281-890-6155
Practice Address - Fax:281-894-2765
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2021-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA02862363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2097479-01Medicaid
TX2097479-01Medicaid
TX310559YNMBMedicare PIN