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General NPI Number Information
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NPI Number | 1922117712
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Entity Type | Individual
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Provider Name | MARY JAN HARGRAVES NURSE PRACTITONER
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Gender | Female
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/26/2009
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Provider Practice Location Address
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Address Line | 2002 HOLCOMBE BLVD
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City | HOUSTON
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State | TX
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Zip | 77030-4211
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Country | US
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Telephone | 713-791-1414
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Fax |
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Provider Business Mailing Address
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Address Line | 131 WILLOWBROOK CT
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City | FISHERVILLE
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State | KY
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Zip | 40023-8450
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Country | US
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Telephone | 713-202-7977
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 235677
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License Number State | TX
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