Provider Demographics
NPI:1962521914
Name:WILLIAMS, TERRIE TUNSTALL (PA)
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:TUNSTALL
Last Name:WILLIAMS
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 1:14903 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2603
Mailing Address - Country:US
Mailing Address - Phone:281-486-7900
Mailing Address - Fax:281-286-8110
Practice Address - Street 1:14903 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-2603
Practice Address - Country:US
Practice Address - Phone:281-486-7900
Practice Address - Fax:281-286-8110
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03731363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03731OtherLICENSE
TXMW1076846OtherDEA
TXPA03731OtherLICENSE
TX8G5160Medicare ID - Type Unspecified