Provider Demographics
NPI:1760085740
Name:WOLVERTON, MOLLY SHANNON (APRN)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:SHANNON
Last Name:WOLVERTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ANN
Other - Last Name:SHANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:211 HIGHLAND CROSS DR STE 105
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-1700
Mailing Address - Country:US
Mailing Address - Phone:713-422-2920
Mailing Address - Fax:
Practice Address - Street 1:211 HIGHLAND CROSS DR STE 105
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-1700
Practice Address - Country:US
Practice Address - Phone:713-422-2920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX942518163WC0200X
TX1033009363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1033009OtherAPRN