Doctor Name: | KATRENIA J WYCOUGH |
NPI Number: | 1023069242 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN, A/GNP-C |
License Number: | 251261 |
Business Practice Address: | 711 W Bay Area Blvd #500 Webster, TX - 775984043 |
Business Phone Number: | 2815542200 |
Business Fax Number: | 2815544340 |
Mailing Address: | 711 W Bay Area Blvd, #500 WEBSTER |
State: | TX |
Postal Code: | 775984043 |
Phone Number: | 2815542200 |
Fax Number: | 2815544340 |
NPI Enumeration Date: | 05/12/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 251261 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |