Healthcare Provider Details

I. General information

NPI: 1477053841
Provider Name (Legal Business Name): AMY MARIE O'CONNELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15882 CHAMPION FOREST DR
SPRING TX
77379-7141
US

IV. Provider business mailing address

5718 WESTHEIMER RD STE 1800
HOUSTON TX
77057-5773
US

V. Phone/Fax

Practice location:
  • Phone: 281-783-8162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP135485
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP135485
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: