Basic Information
Provider Information | |||||||||
NPI: | 1588079958 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KIERSZ MUELLER | ||||||||
FirstName: | BARBARA | ||||||||
MiddleName: | MICHELLE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O., B.S., A.A. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 14960 PARK ROW DR | ||||||||
Address2: |   | ||||||||
City: | HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 770845165 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2812981144 | ||||||||
FaxNumber: | 2812981133 | ||||||||
Practice Location | |||||||||
Address1: | 401 RANCH ROAD 620 S STE 210 | ||||||||
Address2: |   | ||||||||
City: | LAKEWAY | ||||||||
State: | TX | ||||||||
PostalCode: | 787345304 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5123304779 | ||||||||
FaxNumber: | 2812981133 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/24/2014 | ||||||||
LastUpdateDate: | 09/08/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/08/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R2142 | TX | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 6997 | GA | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 2080P0006X | R2142 | TX | Y |   | Allopathic & Osteopathic Physicians | Pediatrics | Developmental – Behavioral Pediatrics |
ID Information
ID | Type | State | Issuer | Description | 374732101 | 05 | TX |   | MEDICAID | 374732102 | 05 | TX |   | MEDICAID |