Provider Demographics
NPI:1417300146
Name:DUTCH, CHARLES M (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:M
Last Name:DUTCH
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9311 ABERDEEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-4940
Mailing Address - Country:US
Mailing Address - Phone:713-677-4193
Mailing Address - Fax:
Practice Address - Street 1:6219 IRVINGTON BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-5951
Practice Address - Country:US
Practice Address - Phone:832-380-2580
Practice Address - Fax:832-380-2583
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily