MEDICARE: REGIONAL NURSE PRACTITIONER SERVICES 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356858062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL NURSE PRACTITIONER SERVICES PLLC

Provider Business Mailing Address
First Line	:	2656 S LOOP W STE 103
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-5632
Country	:	US
Telephone Number	:	713-728-6734
Fax Number	:	713-728-6735

Provider Business Practice Location Address
First Line	:	2656 S LOOP W STE 103
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-5632
Country	:	US
Telephone Number	:	713-728-6734
Fax Number	:	713-728-6735

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. GUERLINE P DEJEAN
Credential	:	NP
Telephone Number	:	713-728-6734

Provider Enumeration Date	:	01/03/2018
Last Update Date	:	06/16/2018

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