Individual
MRS. ERIKA MONTREAL RUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4000
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10923
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
379048701
—
TX
01
—
379048702
MEDICAID CSHCN
TX
Enumeration date
11/05/2016
Last updated
03/01/2018
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