Provider Demographics
NPI:1114155249
Name:PREVOST, NATASHA CHANEL (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:CHANEL
Last Name:PREVOST
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 WESTHEIMER COURT
Mailing Address - Street 2:EMPLOYEE HEALTH CLINIC
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056
Mailing Address - Country:US
Mailing Address - Phone:713-627-5476
Mailing Address - Fax:
Practice Address - Street 1:5400 WESTHEIMER COURT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056
Practice Address - Country:US
Practice Address - Phone:713-627-5476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX776242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily