Healthcare Provider Details

I. General information

NPI: 1265829378
Provider Name (Legal Business Name): CARL CUESTA FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CARL CUESTA NP-C

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 OAK PARK TRAILS CT
KATY TX
77450-6023
US

IV. Provider business mailing address

3726 AUBURN GROVE CIR
MISSOURI CITY TX
77459-6807
US

V. Phone/Fax

Practice location:
  • Phone: 281-706-4143
  • Fax:
Mailing address:
  • Phone: 281-748-5363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP126663
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP126663
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: