MEDICARE: TOYA DEMETRIA CHAMPION FNP-C

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	1116172	TX

General Provider Information

NPI Number	:	1740068956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOYA DEMETRIA CHAMPION FNP-C

Provider Business Mailing Address
First Line	:	11511 SHADOW CREEK PKWY
Second Line	:	HR/CREDENTIALING SERVICES
City	:	PEARLAND
State	:	TX
Zip	:	77584-7298
Country	:	US
Telephone Number	:	713-442-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	17814 W LAKE HOUSTON PKWY
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-3283
Country	:	US
Telephone Number	:	346-674-2000
Fax Number	:

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

Provider Enumeration Date	:	09/19/2023
Last Update Date	:	12/10/2025

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