Provider Demographics
NPI:1356858062
Name:REGIONAL NURSE PRACTITIONER SERVICES PLLC
Entity Type:Organization
Organization Name:REGIONAL NURSE PRACTITIONER SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GUERLINE
Authorized Official - Middle Name:P
Authorized Official - Last Name:DEJEAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:713-728-6734
Mailing Address - Street 1:2656 S LOOP W STE 103
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-5632
Mailing Address - Country:US
Mailing Address - Phone:713-728-6734
Mailing Address - Fax:713-728-6735
Practice Address - Street 1:2656 S LOOP W STE 103
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-5632
Practice Address - Country:US
Practice Address - Phone:713-728-6734
Practice Address - Fax:713-728-6735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165420406Medicaid