Basic Information
Provider Information
NPI: 1033558176
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MITCHELL
FirstName: TREVA
MiddleName: GREEN
NamePrefix: MRS.
NameSuffix:  
Credential: MSN, RN, FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: GREEN
OtherFirstName: TREVA
OtherMiddleName: RENEE
OtherNamePrefix: MISS
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 24048 KUYKENDAHL RD
Address2:  
City: TOMBALL
State: TX
PostalCode: 773755326
CountryCode: US
TelephoneNumber: (281) 255-3897
FaxNumber:  
Practice Location
Address1: 24048 KUYKENDAHL RD
Address2:  
City: TOMBALL
State: TX
PostalCode: 773755326
CountryCode: US
TelephoneNumber: 2812553897
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/21/2013
LastUpdateDate: 07/05/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X124001TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LF0000X714292TXN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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