Provider Demographics
NPI:1437718129
Name:ACHUO, IVO KELLI
Entity Type:Individual
Prefix:
First Name:IVO
Middle Name:KELLI
Last Name:ACHUO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W BAY AREA BLVD STE 602
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4042
Mailing Address - Country:US
Mailing Address - Phone:832-871-4099
Mailing Address - Fax:281-994-7449
Practice Address - Street 1:11914 ASTORIA BLVD STE 590
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089
Practice Address - Country:US
Practice Address - Phone:832-871-4099
Practice Address - Fax:281-994-7449
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF04190281OtherFNP