Provider Demographics
NPI:1598440968
Name:DIVINE HEALING HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:DIVINE HEALING HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:832-876-9673
Mailing Address - Street 1:8145 HWY 6 S
Mailing Address - Street 2:SUITE 112 PMB 1026
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083
Mailing Address - Country:US
Mailing Address - Phone:832-536-6055
Mailing Address - Fax:
Practice Address - Street 1:10834 BRADFORD WAY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-2362
Practice Address - Country:US
Practice Address - Phone:832-536-6055
Practice Address - Fax:713-347-6924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty