MEDICARE: RASHAUNDA WEST WHITAKER APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1028783	TX

General Provider Information

NPI Number	:	1043895840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RASHAUNDA WEST WHITAKER APRN

Provider Business Mailing Address
First Line	:	5503 TARA OAKS CT
Second Line	:
City	:	ROSHARON
State	:	TX
Zip	:	77583-2528
Country	:	US
Telephone Number	:	713-591-6513
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 UVALDE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-3717
Country	:	US
Telephone Number	:	832-409-2244
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2021
Last Update Date	:	03/12/2021

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