MEDICARE: CORDNEY DRIVER FNP

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	1104872	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1104872	OTHER	TX	TEXAS BOARD OF NURSING

General Provider Information

NPI Number	:	1912603424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORDNEY DRIVER FNP

Provider Business Mailing Address
First Line	:	8877 FRANKWAY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-1901
Country	:	US
Telephone Number	:	901-461-2718
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 E EDGEWOOD DR
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-3818
Country	:	US
Telephone Number	:	281-407-5698
Fax Number	:

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

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	02/06/2023

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