MEDICARE: DESIREE MONCHELLE GIVENS

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	363LA2100X	Acute Care Nurse Practitioner	1076964	TX
2	363LA2200X	Adult Health Nurse Practitioner	1076964	TX

General Provider Information

NPI Number	:	1447988712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE MONCHELLE GIVENS

Provider Business Mailing Address
First Line	:	2606 OAKLEAF ASH LN
Second Line	:
City	:	FRESNO
State	:	TX
Zip	:	77545-2162
Country	:	US
Telephone Number	:	469-441-2359
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 FANNIN ST # SM1601
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2717
Country	:	US
Telephone Number	:	281-387-1625
Fax Number	:

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

Provider Enumeration Date	:	08/12/2022
Last Update Date	:	12/13/2022

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