Healthcare Provider Details

I. General information

NPI: 1083730444
Provider Name (Legal Business Name): CHILDREN'S CLINIC OF KATY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 S FRY RD STE 320
KATY TX
77450-2251
US

IV. Provider business mailing address

705 S FRY RD STE 320
KATY TX
77450-2251
US

V. Phone/Fax

Practice location:
  • Phone: 281-829-6860
  • Fax: 281-829-6863
Mailing address:
  • Phone: 281-829-6860
  • Fax: 281-829-6863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberF9876
License Number StateTX

VIII. Authorized Official

Name: DONALD CADE NELMS
Title or Position: PRESIDENT
Credential: MD
Phone: 281-829-6860