Provider Demographics
NPI:1174956254
Name:PICKLE, MAUREEN CATHERINE ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:CATHERINE ELIZABETH
Last Name:PICKLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:CATHERINE ELIZABETH
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7900 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2934
Mailing Address - Country:US
Mailing Address - Phone:713-512-7505
Mailing Address - Fax:
Practice Address - Street 1:7900 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2934
Practice Address - Country:US
Practice Address - Phone:713-512-7505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008485363A00000X, 363A00000X
TXPA17485363A00000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA 9107384OtherLICENCE