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General NPI Number Information
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NPI Number | 1710411616
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Entity Type | Organization
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Legal Business Name | PERSEVERANCE HEATLH INNOVATION LTD
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 21706 WILLOW DOWNS
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City | TOMBALL
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State | TX
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Zip | 77375
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Country | US
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Telephone | 832-380-0216
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Fax | 281-745-4367
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Provider Business Mailing Address
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Address Line | 24646 NORTH FREEWAY 45 N. 200
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City | SPRING
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State | TX
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Zip | 77386
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Country | US
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Telephone | 832-380-0216
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Fax | 281-745-4367
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Authorized Official
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Title or Position | CEO/EXECUTIVE DIRECTOR
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Name | MRS. KIERSTEN CHANTELLE WILLIAMS-BOLTON
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Credential |
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Telephone | 832-380-0216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | N7983
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 7397
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 771216
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License Number State | TX
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