Provider Demographics
NPI:1083180608
Name:TEAGUE, KANEISHA D (NP)
Entity Type:Individual
Prefix:
First Name:KANEISHA
Middle Name:D
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 SAN FELIPE ST STE 500
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-8003
Mailing Address - Country:US
Mailing Address - Phone:281-946-7238
Mailing Address - Fax:
Practice Address - Street 1:4700 W SAM HOUSTON PKWY N STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-8224
Practice Address - Country:US
Practice Address - Phone:713-402-7824
Practice Address - Fax:713-570-0196
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX694339171M00000X
TX1027480363LF0000X
171M00000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator