Healthcare Provider Details

I. General information

NPI: 1164980124
Provider Name (Legal Business Name): JUDY S CUELLO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDY S CRAPPS FNP

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9516 FM 1097 RD W STE 140
WILLIS TX
77318-5867
US

IV. Provider business mailing address

9516 FM 1097 RD W STE 140
WILLIS TX
77318-5867
US

V. Phone/Fax

Practice location:
  • Phone: 936-539-4004
  • Fax: 936-224-4205
Mailing address:
  • Phone: 936-539-4004
  • Fax: 936-224-4205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP140977
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: