Provider Demographics
NPI:1114666203
Name:IVY DRIP IV HYDRATION, AESTHETICS, AND WEIGHT LOSS
Entity Type:Organization
Organization Name:IVY DRIP IV HYDRATION, AESTHETICS, AND WEIGHT LOSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-C
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAINS-BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-721-2629
Mailing Address - Street 1:5330 FRY RD
Mailing Address - Street 2:STE C
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5330 FRY RD
Practice Address - Street 2:STE C
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449
Practice Address - Country:US
Practice Address - Phone:832-721-2629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care