=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225725492
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRITIAN KAMBYL SKAHT GUEST ACNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2023
-----------------------------------------------------
Last Update Date | 04/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6551 BERTNER AVE
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-2807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-790-3311
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8634 HENRICO LN
-----------------------------------------------------
City | ROSENBERG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77469-4876
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-207-6546
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 1113086
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------