MEDICARE: AERIAL STARKS

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1114677176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AERIAL STARKS

Provider Business Mailing Address
First Line	:	21801 NORTHCREST DR APT 1124
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-4062
Country	:	US
Telephone Number	:	183-280-7105
Fax Number	:

Provider Business Practice Location Address
First Line	:	3724 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3528
Country	:	US
Telephone Number	:	346-372-0771
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	03/24/2022

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Directions to “ AERIAL STARKS ” Practice Location

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