Provider Demographics
NPI:1326785791
Name:STACKHOUSE, KESA
Entity Type:Individual
Prefix:
First Name:KESA
Middle Name:
Last Name:STACKHOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 JONES RD APT 1905
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4670
Mailing Address - Country:US
Mailing Address - Phone:832-739-2691
Mailing Address - Fax:
Practice Address - Street 1:9001 JONES RD APT 1905
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4670
Practice Address - Country:US
Practice Address - Phone:832-739-2691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider