Provider Demographics
NPI:1972260875
Name:NYAENYA, JOEL A (NP)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:A
Last Name:NYAENYA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14106 SPRING BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4223
Mailing Address - Country:US
Mailing Address - Phone:832-207-0646
Mailing Address - Fax:
Practice Address - Street 1:4828 LOOP CENTRAL DR STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-2212
Practice Address - Country:US
Practice Address - Phone:713-979-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1021456363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2019074632OtherANCC