Provider Demographics
NPI:1609355734
Name:HUSTON, ERAYNA MICHELLE (RN)
Entity Type:Individual
Prefix:
First Name:ERAYNA
Middle Name:MICHELLE
Last Name:HUSTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8235 AGORA PKWY SUITE 111
Mailing Address - Street 2:BOX 565
Mailing Address - City:SELMA
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1335
Mailing Address - Country:US
Mailing Address - Phone:210-860-8530
Mailing Address - Fax:
Practice Address - Street 1:8700 CROWNHILL BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-824-5530
Practice Address - Fax:210-824-5323
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX921328163WC1600X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development