MEDICARE: DEVAN ARLINE REID

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	390200000X	Student in an Organized Health Care Education/Training Program
2	363LP0200X	Pediatric Nurse Practitioner	1130399	TX

General Provider Information

NPI Number	:	1134820814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVAN ARLINE REID

Provider Business Mailing Address
First Line	:	10915 PIPING ROCK LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-2727
Country	:	US
Telephone Number	:	432-631-5916
Fax Number	:

Provider Business Practice Location Address
First Line	:	10915 PIPING ROCK LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-2727
Country	:	US
Telephone Number	:	432-631-5916
Fax Number	:

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

Provider Enumeration Date	:	03/10/2023
Last Update Date	:	08/15/2023

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Directions to “ DEVAN ARLINE REID ” Practice Location

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