Healthcare Provider Details

I. General information

NPI: 1467858282
Provider Name (Legal Business Name): ELIZABETH SKOTNICKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5656 KELLEY ST LBJ OUTPATIENT CENTER
HOUSTON TX
77026-1967
US

IV. Provider business mailing address

5656 KELLEY ST
HOUSTON TX
77026
US

V. Phone/Fax

Practice location:
  • Phone: 713-566-9236
  • Fax: 713-566-6150
Mailing address:
  • Phone: 713-566-4463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberAP128850
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP128850
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: