Healthcare Provider Details

I. General information

NPI: 1427435296
Provider Name (Legal Business Name): LEIGH ANN HOUSTON, RN FIRST ASSIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 STONEHENGE DR
HERNANDO MS
38632
US

IV. Provider business mailing address

PO BOX 38
ROWLETT TX
75030-0038
US

V. Phone/Fax

Practice location:
  • Phone: 214-227-2457
  • Fax:
Mailing address:
  • Phone: 214-227-2457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number809926
License Number StateMS

VIII. Authorized Official

Name: LEIGH ANN HOUSTON
Title or Position: RN FIRST ASSIST
Credential:
Phone: 214-227-2457