MEDICARE: KINGWOOD FAMILY PRACTICE ASSOCIATES

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	207Q00000X	Family Medicine Physician		TX

General Provider Information

NPI Number	:	1760662647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGWOOD FAMILY PRACTICE ASSOCIATES

Provider Business Mailing Address
First Line	:	1850 W LAKE HOUSTON PKWY
Second Line	:	190
City	:	KINGWOOD
State	:	TX
Zip	:	77339-5237
Country	:	US
Telephone Number	:	281-361-2902
Fax Number	:	281-361-5792

Provider Business Practice Location Address
First Line	:	1850 W LAKE HOUSTON PKWY
Second Line	:	190
City	:	KINGWOOD
State	:	TX
Zip	:	77339-5237
Country	:	US
Telephone Number	:	281-361-2902
Fax Number	:	281-361-5792

Authorized Official
Title or Position	:	M.D./OWNER
Name	:	DR. STEPHANIE LYNN GROSS PIERCE
Credential	:	M.D.
Telephone Number	:	281-361-2902

Provider Enumeration Date	:	11/08/2007
Last Update Date	:	11/05/2012

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