Healthcare Provider Details

I. General information

NPI: 1235479791
Provider Name (Legal Business Name): LATANYA GRAYLYN FORD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 BROADWAY ST
PEARLAND TX
77581-4507
US

IV. Provider business mailing address

2900 BROADWAY ST
PEARLAND TX
77581-4507
US

V. Phone/Fax

Practice location:
  • Phone: 281-997-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP122362
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: