MEDICARE: KINGDOM HOUSE CALLS LLC

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
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1902597537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGDOM HOUSE CALLS LLC

Provider Business Mailing Address
First Line	:	4110 ALMEDA RD # 8364
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-4869
Country	:	US
Telephone Number	:	832-577-7925
Fax Number	:

Provider Business Practice Location Address
First Line	:	5446 SHAMROCK ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77017-5630
Country	:	US
Telephone Number	:	832-577-7925
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	GINA COWAN
Credential	:	COO
Telephone Number	:	832-577-7925

Provider Enumeration Date	:	05/16/2023
Last Update Date	:	03/26/2026

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Directions to “KINGDOM HOUSE CALLS LLC ” Practice Location

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