Provider Demographics
NPI:1942583547
Name:KOTZUR, STEPHANIE (ACNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KOTZUR
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 N SAM HOUSTON PKWY E STE 516
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-5915
Mailing Address - Country:US
Mailing Address - Phone:832-456-2009
Mailing Address - Fax:
Practice Address - Street 1:650 N SAM HOUSTON PKWY E STE 516
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-5915
Practice Address - Country:US
Practice Address - Phone:281-620-6761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX716688363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2950727Medicaid
TX2950727Medicaid