MEDICARE: NIGHTLIGHT AFTER HOURS PEDIATRICS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1043746654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIGHTLIGHT AFTER HOURS PEDIATRICS PLLC

Provider Business Mailing Address
First Line	:	1814 FOUNTAIN VIEW DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-3004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1814 FOUNTAIN VIEW DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-3004
Country	:	US
Telephone Number	:	713-957-2020
Fax Number	:	281-325-1060

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/OWNER
Name	:	ANASTASIA GENTLES
Credential	:	M.D
Telephone Number	:	832-202-6285

Provider Enumeration Date	:	05/03/2017
Last Update Date	:	01/30/2023

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