Healthcare Provider Details

I. General information

NPI: 1023592961
Provider Name (Legal Business Name): CHRISTI L. ROQUEMORE-GORDY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9432 KATY FWY STE 400
HOUSTON TX
77055-6367
US

IV. Provider business mailing address

4629 WAYCROSS DR
HOUSTON TX
77035-3723
US

V. Phone/Fax

Practice location:
  • Phone: 832-244-4621
  • Fax:
Mailing address:
  • Phone: 713-598-7721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP138030
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: