MEDICARE: DYCHETTA MINOR NP

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	363LA2200X	Adult Health Nurse Practitioner	1200595	TX

General Provider Information

NPI Number	:	1295620219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYCHETTA MINOR NP

Provider Business Mailing Address
First Line	:	3422 BUSINESS CENTER DR STE 106
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-4159
Country	:	US
Telephone Number	:	832-890-6814
Fax Number	:	832-890-6814

Provider Business Practice Location Address
First Line	:	9415 BROADWAY ST STE 201
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-8094
Country	:	US
Telephone Number	:	832-890-6814
Fax Number	:

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

Provider Enumeration Date	:	06/10/2025
Last Update Date	:	06/10/2025

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