Provider Demographics
NPI:1134680341
Name:HOUSTON, DEIDRA MICHELLE (LVN)
Entity Type:Individual
Prefix:
First Name:DEIDRA
Middle Name:MICHELLE
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1347
Mailing Address - Street 2:
Mailing Address - City:SEAGRAVES
Mailing Address - State:TX
Mailing Address - Zip Code:79359-1347
Mailing Address - Country:US
Mailing Address - Phone:806-893-1714
Mailing Address - Fax:
Practice Address - Street 1:1207 16TH ST
Practice Address - Street 2:
Practice Address - City:SEAGRAVES
Practice Address - State:TX
Practice Address - Zip Code:79359-1347
Practice Address - Country:US
Practice Address - Phone:806-893-1714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233142164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse