Healthcare Provider Details

I. General information

NPI: 1063317543
Provider Name (Legal Business Name): ALLY FERNANDEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2026
Last Update Date: 11/03/2026
Certification Date: 11/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 ROLLINGBROOK DR # 125
BAYTOWN TX
77521-3656
US

IV. Provider business mailing address

2223 ROLLINGBROOK DR # 125
BAYTOWN TX
77521-3656
US

V. Phone/Fax

Practice location:
  • Phone: 281-420-3565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20901
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: