Healthcare Provider Details

I. General information

NPI: 1235962598
Provider Name (Legal Business Name): BEVERLY ONGAM ASOH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13135 LAWSONS CREEK LN
HOUSTON TX
77072-0121
US

IV. Provider business mailing address

13135 LAWSONS CREEK LN
HOUSTON TX
77072-0121
US

V. Phone/Fax

Practice location:
  • Phone: 817-368-4130
  • Fax:
Mailing address:
  • Phone: 817-368-4130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1169471
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1169471
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1169471
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number1169471
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1169471
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: