Provider Demographics
NPI:1790333680
Name:HOUSTON, ANGELA (MSN, MED, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:MSN, MED, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5426
Mailing Address - Country:US
Mailing Address - Phone:575-887-2455
Mailing Address - Fax:575-234-2945
Practice Address - Street 1:202 W. CHURCH STREET
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220
Practice Address - Country:US
Practice Address - Phone:575-887-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM57377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily