Provider Demographics
NPI:1639818792
Name:CRIDDELL, BEHEIRRA (NP)
Entity Type:Individual
Prefix:
First Name:BEHEIRRA
Middle Name:
Last Name:CRIDDELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BEHEIRRA
Other - Middle Name:
Other - Last Name:CRIDDELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:2711 INTREPID TRL
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-6319
Mailing Address - Country:US
Mailing Address - Phone:832-647-5961
Mailing Address - Fax:
Practice Address - Street 1:12660 BEECHNUT ST STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-3982
Practice Address - Country:US
Practice Address - Phone:281-564-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1073905363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily