Healthcare Provider Details

I. General information

NPI: 1497074207
Provider Name (Legal Business Name): ANGELA WEST GOODEN RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA SHEREE WEST RN

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN ST CARDIOLOGY, 19-345C
HOUSTON TX
77030-2303
US

IV. Provider business mailing address

6621 FANNIN ST CARDIOLOGY, 19-345C
HOUSTON TX
77030-2303
US

V. Phone/Fax

Practice location:
  • Phone: 832-826-1937
  • Fax: 832-825-1107
Mailing address:
  • Phone: 832-826-1937
  • Fax: 832-825-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number662468
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number662468
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: