MEDICARE: NATASSIA CLEAVES NP

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	363L00000X	Nurse Practitioner	19523	TN
2	363L00000X	Nurse Practitioner	AP131847	TX

General Provider Information

NPI Number	:	1619365988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASSIA CLEAVES NP

Provider Business Mailing Address
First Line	:	1302 WAUGH DR # 533
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-3908
Country	:	US
Telephone Number	:	844-342-2227
Fax Number	:	713-401-9758

Provider Business Practice Location Address
First Line	:	3838 N SAM HOUSTON PKWY E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77032-3400
Country	:	US
Telephone Number	:	844-342-2227
Fax Number	:	713-401-9758

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

Provider Enumeration Date	:	01/08/2015
Last Update Date	:	07/15/2023

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