Provider Demographics
NPI:1265082358
Name:MOURET, KEAGAN GLYN (RN)
Entity type:Individual
Prefix:
First Name:KEAGAN
Middle Name:GLYN
Last Name:MOURET
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 SOUTHWEST FWY STE 140
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-4609
Mailing Address - Country:US
Mailing Address - Phone:713-441-2779
Mailing Address - Fax:
Practice Address - Street 1:2615 SOUTHWEST FWY STE 140
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4609
Practice Address - Country:US
Practice Address - Phone:713-441-2779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145185363L00000X
TX881703163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency