Healthcare Provider Details

I. General information

NPI: 1457935314
Provider Name (Legal Business Name): ANGELA CAIN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 CAROLINE ST
HOUSTON TX
77004-1114
US

IV. Provider business mailing address

1237 10TH ST
SAN LEON TX
77539-2498
US

V. Phone/Fax

Practice location:
  • Phone: 713-970-7000
  • Fax:
Mailing address:
  • Phone: 281-508-1839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number1036825
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: