Provider Demographics
NPI:1699008060
Name:VARGHESE, SIMI R (NP)
Entity Type:Individual
Prefix:MRS
First Name:SIMI
Middle Name:R
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:SIMI
Other - Middle Name:M
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4009
Practice Address - Country:US
Practice Address - Phone:713-745-3545
Practice Address - Fax:703-792-6161
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX764815363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX307598803Medicaid
363442YKQHOtherMEDICARE PTAN#
363442YKQHOtherMEDICARE PTAN#