Prestige Healthcare LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

706578 Issued in TX

Legal business name

PRESTIGE HEALTHCARE LLC

Practice address

4235 Fernside Dr
Pasadena, TX 77505-4226

Phone

(806) 470-5450

NPI assigned

Jan 8, 2014

Last updated

Jan 8, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Angela L Fleenor, RN, MSN, FNP-BC

Title

Ceo

Phone

(806) 470-5450

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389139200000",
    "number": "1548682750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4235 FERNSIDE DR",
            "city": "PASADENA",
            "state": "TX",
            "postal_code": "775054226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4235 FERNSIDE DR",
            "city": "PASADENA",
            "state": "TX",
            "postal_code": "775054226",
            "telephone_number": "806-470-5450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-08",
        "last_updated": "2014-01-08",
        "status": "A",
        "authorized_official_last_name": "FLEENOR",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "806-470-5450",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, MSN, FNP-BC"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "706578",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1457789497",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Pasadena, TX
• Providers in Pasadena, TX by specialty
• Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.