Provider Demographics
NPI:1235279225
Name:STONE, SUSAN M (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:STONE
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 1:6431 FANNIN ST # 3.286
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1631 NORTH LOOP W STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1530
Practice Address - Country:US
Practice Address - Phone:713-486-7900
Practice Address - Fax:713-486-3590
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP105468176B00000X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163962703Medicaid
TXP00600829OtherRAILROAD MEDICARE
TX8Y1548OtherBCBS
TXQ10140Medicare UPIN
TX8J1959Medicare PIN