Healthcare Provider Details

I. General information

NPI: 1881140705
Provider Name (Legal Business Name): LETRICE K MASON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 07/25/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 W ALABAMA ST
HOUSTON TX
77006-4102
US

IV. Provider business mailing address

1622 W ALABAMA ST
HOUSTON TX
77006-4102
US

V. Phone/Fax

Practice location:
  • Phone: 832-808-0903
  • Fax: 832-553-7762
Mailing address:
  • Phone: 832-808-0903
  • Fax: 832-553-7762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number821405
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP33303
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number821405
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP133303
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: