Healthcare Provider Details

I. General information

NPI: 1306405105
Provider Name (Legal Business Name): PATRICK LAWRENCE MARSTON ESCAMILLA FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12141 RICHMOND AVE
HOUSTON TX
77082-2408
US

IV. Provider business mailing address

15882 CHAMPION FOREST DR
SPRING TX
77379-7141
US

V. Phone/Fax

Practice location:
  • Phone: 281-588-8110
  • Fax:
Mailing address:
  • Phone: 281-783-8162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP141703
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP141703
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: