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NPI Code Detail

MEDICARE: KEVIN M PRINCE FNP

MEDICARE: KEVIN M PRINCE FNP
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
1363LF0000XFamily Nurse PractitionerAP113090TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18N7097OTHERTXBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558396465
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN M PRINCE FNP
Provider Business Mailing Address
First Line : 1108 GULF FWY S
Second Line : STE 230
City : LEAGUE CITY
State : TX
Zip : 77573-5100
Country : US
Telephone Number : 281-557-4404
Fax Number : 281-557-4443
Provider Business Practice Location Address
First Line : 538 BROADWAY
Second Line :
City : WINNIE
State : TX
Zip : 77665-7600
Country : US
Telephone Number : 409-296-6000
Fax Number : 409-296-6375
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 04/25/2023

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