Healthcare Provider Details

I. General information

NPI: 1902584568
Provider Name (Legal Business Name): HALARIA ANDERSON WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date: 08/21/2025
Reactivation Date: 10/14/2025

III. Provider practice location address

7833 AUGUSTA PINES DR APT 2403
SPRING TX
77389-1877
US

IV. Provider business mailing address

7833 AUGUSTA PINES DR APT 2403
SPRING TX
77389-1877
US

V. Phone/Fax

Practice location:
  • Phone: 281-318-9980
  • Fax:
Mailing address:
  • Phone: 281-318-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: