Provider Demographics
NPI:1841669819
Name:SHAW, PATRICE MILLER (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:MILLER
Last Name:SHAW
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:PATRICE
Other - Middle Name:NICOLA
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:10021 MAIN ST STE B3
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5254
Mailing Address - Country:US
Mailing Address - Phone:832-834-3800
Mailing Address - Fax:281-351-2035
Practice Address - Street 1:10021 MAIN ST STE B3
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5254
Practice Address - Country:US
Practice Address - Phone:832-834-3800
Practice Address - Fax:713-748-4444
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128856363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX357583901Medicaid