Healthcare Provider Details

I. General information

NPI: 1588295034
Provider Name (Legal Business Name): VICTORIA TAYESE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8588 KATY FWY STE 226A
HOUSTON TX
77024-1881
US

IV. Provider business mailing address

19823 CREEKSHORE DR
KATY TX
77449-4387
US

V. Phone/Fax

Practice location:
  • Phone: 713-532-6884
  • Fax:
Mailing address:
  • Phone: 646-691-2958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number461629-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF348784-01
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: