Provider Demographics
NPI:1407560584
Name:GEORGE, AUDREY
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:GEORGE
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 1:1301 GREENS PKWY # 101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-4155
Mailing Address - Country:US
Mailing Address - Phone:346-313-5620
Mailing Address - Fax:
Practice Address - Street 1:403 VAN MOLAN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-6149
Practice Address - Country:US
Practice Address - Phone:346-313-5620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA0000071539364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term CareGroup - Single Specialty