Healthcare Provider Details

I. General information

NPI: 1699303875
Provider Name (Legal Business Name): RANI WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 WEST LOOP S
BELLAIRE TX
77401-2103
US

IV. Provider business mailing address

4247 SHAYS MANOR LN
RICHMOND TX
77406-7230
US

V. Phone/Fax

Practice location:
  • Phone: 713-314-4444
  • Fax:
Mailing address:
  • Phone: 339-970-4563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP145621
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP145621
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: