Healthcare Provider Details

I. General information

NPI: 1053969956
Provider Name (Legal Business Name): VINCENT KANAYATHU ALEXANDER FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9055 KATY FWY STE 200
HOUSTON TX
77024-1629
US

IV. Provider business mailing address

PO BOX 392929
PITTSBURGH PA
15251-9900
US

V. Phone/Fax

Practice location:
  • Phone: 713-461-2915
  • Fax: 713-461-5307
Mailing address:
  • Phone: 713-461-2915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP138334
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: