NURSE PRACTITIONER PROVIDER NPI 1053624015

NPI Information

NPI: 1053624015
Provider Name: NURSE PRACTITIONER PROVIDER
Classification: Clinic/Center - 261QH0100X
Specialization: Health Service
Entity Type: Organization
Address: 2626 S LOOP W
350
HOUSTON, TX
ZIP 77054
Phone: (713) 334-1003

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NPI Details

NURSE PRACTITIONER PROVIDER is a health service clinic center in Houston, TX. NURSE PRACTITIONER PROVIDER NPI is 1053624015. The provider is registered as an organization entity type.

The provider's business location address is:

2626 S LOOP W
350
HOUSTON, TX
ZIP 77054-654
Phone: (713) 334-1003

The provider's authorized official is Rhonjean Gordon .
The authorized official title is Nurse Practitioner and has the following contact phone number (281) 686-4469.

The enumeration date for this NPI number is 7/20/2010 and was last updated on 7/20/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QH0100X	Clinic/Center	Health Service			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	185033102	MEDICAID	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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