Provider Demographics
NPI:1003384439
Name:KEBENEI, ERICK K (NP)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:K
Last Name:KEBENEI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19731 SHALLOW SHAFT LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-4101
Mailing Address - Country:US
Mailing Address - Phone:913-526-0564
Mailing Address - Fax:
Practice Address - Street 1:650 N SAM HOUSTON PKWY E STE 307
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-5906
Practice Address - Country:US
Practice Address - Phone:281-616-6769
Practice Address - Fax:832-201-0407
Is Sole Proprietor?:No
Enumeration Date:2018-11-03
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139632363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily