Healthcare Provider Details

I. General information

NPI: 1649772716
Provider Name (Legal Business Name): NICOLE COUVILLON FAWCETT AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 WESLAYAN ST STE 350
HOUSTON TX
77027-5733
US

IV. Provider business mailing address

PO BOX 873
BELLAIRE TX
77402-0873
US

V. Phone/Fax

Practice location:
  • Phone: 713-533-1700
  • Fax: 713-533-1708
Mailing address:
  • Phone: 713-533-1700
  • Fax: 713-533-1708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP136808
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP136808
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: