Provider Demographics
NPI:1740058247
Name:A&S VITALITY HEALTHCARE SERVICES
Entity type:Organization
Organization Name:A&S VITALITY HEALTHCARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER 1
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:NGWASHA
Authorized Official - Last Name:NCHONKO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:469-667-5895
Mailing Address - Street 1:5806 BALDWIN ELM ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-7092
Mailing Address - Country:US
Mailing Address - Phone:469-667-5895
Mailing Address - Fax:
Practice Address - Street 1:8200 WEDNESBURY LN STE 270
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2900
Practice Address - Country:US
Practice Address - Phone:832-974-0516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861978389OtherNPPES (NPI)