Healthcare Provider Details

I. General information

NPI: 1508698564
Provider Name (Legal Business Name): DESIREE BANTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2244 W HOLCOMBE BLVD
HOUSTON TX
77030-2008
US

IV. Provider business mailing address

2244 W HOLCOMBE BLVD
HOUSTON TX
77030-2008
US

V. Phone/Fax

Practice location:
  • Phone: 713-636-2621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number335410
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1172495
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11033712
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: