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General NPI Number Information
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NPI Number | 1871033290
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Entity Type | Organization
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Legal Business Name | PROMENADE HEALTHCARE, PLLC
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Dates
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Enumeration Date | 03/04/2017
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 2611 CYPRESS CREEK PKWY STE B100
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City | HOUSTON
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State | TX
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Zip | 77068-3730
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Country | US
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Telephone | 713-904-5150
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Fax |
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Provider Business Mailing Address
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Address Line | 2611 CYPRESS CREEK PKWY STE B100
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City | HOUSTON
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State | TX
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Zip | 77068-3730
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Country | US
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Telephone | 713-904-5150
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Fax | 713-955-9698
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER/OWNER
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Name | DR. AZIZI SHANI JOHNSON-AUBERT
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Credential | FNP-C
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Telephone | 832-250-7007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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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 | 702507
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License Number State | TX
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