Healthcare Provider Details

I. General information

NPI: 1467959916
Provider Name (Legal Business Name): NICOLE SCHROCK RUGGLES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 EAST RD STE 3236
HOUSTON TX
77054-6010
US

IV. Provider business mailing address

1941 EAST RD STE 3236
HOUSTON TX
77054-6010
US

V. Phone/Fax

Practice location:
  • Phone: 713-486-2570
  • Fax: 713-486-2565
Mailing address:
  • Phone: 713-486-2570
  • Fax: 713-486-2565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberT6699
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: