Provider Demographics
NPI:1740759182
Name:MOZEYEN, HOUSSAM MAHMOUD (FNP)
Entity Type:Individual
Prefix:
First Name:HOUSSAM
Middle Name:MAHMOUD
Last Name:MOZEYEN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5719 INDIGO TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-6219
Mailing Address - Country:US
Mailing Address - Phone:832-818-2195
Mailing Address - Fax:
Practice Address - Street 1:5719 INDIGO TRAILS DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469
Practice Address - Country:US
Practice Address - Phone:832-818-2195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138179363L00000X
LA212148363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner