MEDICARE: USHUS KURUVILLA JOE FNP-BC

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	363LF0000X	Family Nurse Practitioner	AP126689	TX

General Provider Information

NPI Number	:	1609272574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	USHUS KURUVILLA JOE FNP-BC

Provider Business Mailing Address
First Line	:	6234 LEDGER LN
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-2241
Country	:	US
Telephone Number	:	909-802-4783
Fax Number	:

Provider Business Practice Location Address
First Line	:	7701 W BELLFORT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2104
Country	:	US
Telephone Number	:	909-802-4783
Fax Number	:

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

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	03/15/2016

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