Healthcare Provider Details

I. General information

NPI: 1194615823
Provider Name (Legal Business Name): ANGIE LOUISE KUYKENDALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2025
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3886 EVERLY BEND DR
SPRING TX
77386-4467
US

IV. Provider business mailing address

3886 EVERLY BEND DR
SPRING TX
77386-4467
US

V. Phone/Fax

Practice location:
  • Phone: 281-781-3199
  • Fax:
Mailing address:
  • Phone: 281-781-3199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: