Healthcare Provider Details

I. General information

NPI: 1417382474
Provider Name (Legal Business Name): N & K MULTISPECIALTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17030 NANES DR STE 109
HOUSTON TX
77090-2500
US

IV. Provider business mailing address

17030 NANES DR STE 109
HOUSTON TX
77090-2500
US

V. Phone/Fax

Practice location:
  • Phone: 713-873-8100
  • Fax: 713-873-8101
Mailing address:
  • Phone: 713-873-8100
  • Fax: 713-873-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LILY WOLDU
Title or Position: MEMBER
Credential: OT
Phone: 832-331-8450