Provider Demographics
NPI:1760791073
Name:DESHIELD, PRECIOUS
Entity Type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:
Last Name:DESHIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DBA
Other - Middle Name:
Other - Last Name:MEDPSYCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14601 BELLAIRE BLVD
Mailing Address - Street 2:145
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-2505
Mailing Address - Country:US
Mailing Address - Phone:281-578-0019
Mailing Address - Fax:
Practice Address - Street 1:14601 BELLAIRE BLVD
Practice Address - Street 2:145
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-2505
Practice Address - Country:US
Practice Address - Phone:281-578-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011330374U00000X, 163WW0000X, 163WH0200X
376K00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011330OtherDADS
TX011330OtherHOME HEALTHCARE AGENCY
TX194394601Medicaid
TX011330OtherHOME HEALTHCARE AGENCY