Organization
KATY PEDIATRIC ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTIN FULLEN NP (NURSE PRACTIONER)
(281) 492-7676
Entity
Organization
Contact information
Practice address
2051 GREENHOUSE RD STE 120, HOUSTON, TX 77084-7305
(281) 492-7676
(281) 492-8133
Mailing address
2051 GREENHOUSE RD STE 120, HOUSTON, TX 77084-7305
(281) 492-7676
(281) 492-8133
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016KB
BLUE BLUE SHIELD OF TEXAS
TX
05
—
121010602
—
TX
Enumeration date
01/07/2008
Last updated
02/07/2025
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