Healthcare Provider Details

I. General information

NPI: 1356989073
Provider Name (Legal Business Name): HEAVEN SIMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3334 RICHMOND AVE STE 206
HOUSTON TX
77098-3023
US

IV. Provider business mailing address

3334 RICHMOND AVE STE 206
HOUSTON TX
77098-3023
US

V. Phone/Fax

Practice location:
  • Phone: 832-262-1128
  • Fax:
Mailing address:
  • Phone: 832-262-1128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number899350
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: