Provider Demographics
NPI:1356199855
Name:TEKLE, ROSE (APRN)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:TEKLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:TEKLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12670 BISSONNET ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-1337
Mailing Address - Country:US
Mailing Address - Phone:281-988-4829
Mailing Address - Fax:
Practice Address - Street 1:13203 DUSTY GROVE LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-7425
Practice Address - Country:US
Practice Address - Phone:281-770-9269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1155655363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty