Provider Demographics
NPI:1699199166
Name:KATY NEURO & WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:KATY NEURO & WELLNESS CENTER PLLC
Other - Org Name:KATY COPPERFIELD PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:ALONSO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:281-345-7547
Mailing Address - Street 1:4600 HIGHWAY 6 N
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-2884
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4600 HIGHWAY 6 N
Practice Address - Street 2:SUITE 207
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-2884
Practice Address - Country:US
Practice Address - Phone:281-345-7547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX721070363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty