Provider Demographics
NPI:1295388510
Name:CONTRERAS, IVY ATHENA (APRN)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:ATHENA
Last Name:CONTRERAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:IVY
Other - Middle Name:ATHENA
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:6410 FANNIN ST STE 600
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-5206
Mailing Address - Country:US
Mailing Address - Phone:832-325-7211
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST STE 600
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5206
Practice Address - Country:US
Practice Address - Phone:832-325-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142275363LA2200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty