Provider Demographics
NPI:1336436971
Name:LANDRY, VICTORIA ANNE (ANP)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:ANNE
Last Name:LANDRY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 BEECHNUT ST
Mailing Address - Street 2:STE 218
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-1825
Mailing Address - Country:US
Mailing Address - Phone:713-521-0006
Mailing Address - Fax:
Practice Address - Street 1:4660 BEECHNUT ST
Practice Address - Street 2:STE 218
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-1825
Practice Address - Country:US
Practice Address - Phone:713-521-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-04
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX801548363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX295170901Medicaid
TX866N87OtherBCBS
TX295170901Medicaid