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General NPI Number Information
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NPI Number | 1972864197
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Entity Type | Organization
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Legal Business Name | ELITE PRACTITIONERS OF TEXAS LLC
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Dates
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Enumeration Date | 06/05/2012
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Last Update Date | 06/05/2012
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Provider Practice Location Address
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Address Line | 9022 MAJESTY LN
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City | RICHMOND
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State | TX
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Zip | 77469-5698
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Country | US
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Telephone | 832-500-5144
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Fax |
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Provider Business Mailing Address
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Address Line | 9022 MAJESTY LN
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City | RICHMOND
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State | TX
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Zip | 77469-5698
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Country | US
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Telephone | 832-500-5144
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Fax |
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Authorized Official
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Title or Position | NP-C, CRNFA
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Name | BRENT EATON
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Credential | NP-C, CRNFA
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Telephone | 832-600-5144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 680804
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License Number State | TX
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