Provider Demographics
NPI:1700484276
Name:BACOTE-BROWN, PRINCESS
Entity Type:Individual
Prefix:
First Name:PRINCESS
Middle Name:
Last Name:BACOTE-BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 CHEYENNE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-8099
Mailing Address - Country:US
Mailing Address - Phone:281-369-0202
Mailing Address - Fax:
Practice Address - Street 1:1038 CHEYENNE RIDGE DR
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-8099
Practice Address - Country:US
Practice Address - Phone:281-369-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider