Provider Demographics
NPI:1962776377
Name:BOUSE, ROSEMARY DRYSDALE (PA-C)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:DRYSDALE
Last Name:BOUSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2636 S LOOP W
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2680
Mailing Address - Country:US
Mailing Address - Phone:832-834-3800
Mailing Address - Fax:
Practice Address - Street 1:2636 S LOOP W
Practice Address - Street 2:SUITE 105
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2680
Practice Address - Country:US
Practice Address - Phone:832-834-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3232126Medicaid
TX299507YN9CMedicare Oscar/Certification