Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 711462 | TX |
N | 363LP2300X | Nurse Practitioner - Primary Care | AP123576 | TX |
NPI | 1053757179 |
---|---|
Provider Name | Ms. Pheba Pappachan |
First Address | Houston, TX 77015-3656 |
Second Address | Houston, TX 77015-3656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2013 |
Last Update Date | 26/09/2018 |