MEDICARE: MRS. BALISTINE ANTHEREAN ANDERSON PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		TX

General Provider Information

NPI Number	:	1306971528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BALISTINE ANTHEREAN ANDERSON PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	6701 FANNIN ST STE 1510
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2613
Country	:	US
Telephone Number	:	832-822-4242
Fax Number	:

Provider Business Practice Location Address
First Line	:	6701 FANNIN ST STE 1510
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2613
Country	:	US
Telephone Number	:	832-822-4242
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	10/02/2022

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