Individual
CAROLINE MACKENZIE FUGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6701 FANNIN ST STE 1210, HOUSTON, TX 77030-2612
(832) 824-1000
Mailing address
920 WESTCOTT ST APT 240, HOUSTON, TX 77007-5684
(214) 952-1637
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA15955
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA15955
TEXAS PHYSICIAN ASSISTANT LICENSE NUMBER
TX
Enumeration date
10/05/2022
Last updated
10/05/2022
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