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General NPI Number Information
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NPI Number | 1184513590
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Entity Type | Individual
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Provider Name | QUIANA CLARK
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Gender | Female
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 15702 BRIARSTEAD DR
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City | MISSOURI CITY
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State | TX
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Zip | 77489-3540
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Country | US
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Telephone | 832-889-2247
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Fax |
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Provider Business Mailing Address
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Address Line | 12645 MEMORIAL DR STE F1
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City | HOUSTON
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State | TX
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Zip | 77024-4979
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Country | US
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Telephone | 346-641-4449
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | NA0008902960
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License Number State | TX
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