Healthcare Provider Details

I. General information

NPI: 1538563770
Provider Name (Legal Business Name): AMBER GAY FICHTNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 KIRBY DRIVE SUITE B212
HOUSTON TX
77098
US

IV. Provider business mailing address

2800 KIRBY DRIVE SUITE B212
HOUSTON TX
77098
US

V. Phone/Fax

Practice location:
  • Phone: 832-247-9930
  • Fax:
Mailing address:
  • Phone: 832-247-9930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: