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General NPI Number Information
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NPI Number | 1417208539
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Entity Type | Organization
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Legal Business Name | ADRIENNE L MYNATT
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 09/28/2012
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Provider Practice Location Address
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Address Line | 2611 CYPRESS CREEK PKWY STE D102
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City | HOUSTON
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State | TX
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Zip | 77068-3731
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Country | US
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Telephone | 281-440-7399
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Fax | 281-440-7403
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Provider Business Mailing Address
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Address Line | 2611 CYPRESS CREEK PKWY STE D102
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City | HOUSTON
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State | TX
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Zip | 77068-3731
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Country | US
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Telephone | 281-440-7399
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Fax | 281-440-7403
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Authorized Official
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Title or Position | OWNER / NURSE PRACTITIONER
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Name | ADRIENNE L MYNATT
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Credential | NURSE PRACTITIONER
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Telephone | 281-440-7399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 720296
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License Number State | TX
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