Healthcare Provider Details

I. General information

NPI: 1821483520
Provider Name (Legal Business Name): FAYSHALEE ALRICA-MCKENZIE ORTIZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6725 ATASCOCITA RD STE A
HUMBLE TX
77346
US

IV. Provider business mailing address

6725 ATASCOCITA RD STE A
HUMBLE TX
77346-2292
US

V. Phone/Fax

Practice location:
  • Phone: 281-812-3990
  • Fax: 281-812-3947
Mailing address:
  • Phone: 281-812-3990
  • Fax: 281-812-3947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP127848
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP127848
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: