Provider Demographics
NPI:1215976345
Name:COULTER, JULIE K (PA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:K
Last Name:COULTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4627
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4627
Mailing Address - Country:US
Mailing Address - Phone:281-955-7577
Mailing Address - Fax:281-955-5875
Practice Address - Street 1:11800 FM 1960 RD W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3840
Practice Address - Country:US
Practice Address - Phone:281-955-7577
Practice Address - Fax:281-955-5875
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02925363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y0051OtherBCBS PROVIDER NUMBER
TXP26237Medicare UPIN