Healthcare Provider Details

I. General information

NPI: 1740806512
Provider Name (Legal Business Name): YANCI ROCIO MEJIA AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 NORTH LOOP W
HOUSTON TX
77008-1532
US

IV. Provider business mailing address

19255 PARK ROW STE 106
HOUSTON TX
77084-7310
US

V. Phone/Fax

Practice location:
  • Phone: 713-867-2000
  • Fax:
Mailing address:
  • Phone: 713-965-6444
  • Fax: 877-810-6062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP145577
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: