Provider Demographics
NPI:1790193316
Name:ERVIN, EMILY (APRN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:ERVIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 WIGTON DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-4227
Mailing Address - Country:US
Mailing Address - Phone:281-769-2074
Mailing Address - Fax:
Practice Address - Street 1:7789 SOUTHWEST FWY STE 350
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1831
Practice Address - Country:US
Practice Address - Phone:713-778-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily