Provider Demographics
NPI:1447748504
Name:HUSTEDT, JOHN NICHOLAS (NP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:NICHOLAS
Last Name:HUSTEDT
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 LAKE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1760
Mailing Address - Country:US
Mailing Address - Phone:713-540-3620
Mailing Address - Fax:
Practice Address - Street 1:17200 ST LUKES WAY
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8007
Practice Address - Country:US
Practice Address - Phone:713-540-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136420363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner