Athena Medical Clinic LLC
Organization Active NPI Nurse Practitioner · Brookshire, TX
NPI 1760102644 · NPPES record last updated Jun 23, 2023
Key facts
- NPI
- 1760102644
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nurse Practitioner 363L00000X
- Legal business name
- ATHENA MEDICAL CLINIC LLC
- Practice address
- 30575 Kingsland Blvd # 150
Brookshire, TX 77423-2844 - Phone
- (281) 717-4674
- NPI assigned
- Aug 31, 2022
- Organization subpart
- No
Authorized official
- Name
- Iolani Mae Sy Aves, NP
- Title
- Managing Member
- Phone
- (713) 584-9013
Practitioners 4
-
Danielle Marie Inferrera, FNP-C
-
Dunia Altameemi, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2269456 | Athena Medical Clinic | Provider-performed microscopy | Sep 26, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221026001817 | TX | Part B Supplier - Clinic/Group Practice | 2163898511 |
Receives reassigned benefits from 2 practitioners Practice locations: Brookshire, TX |
National Provider Directory
Locations
30575 Kingsland Blvd
Ste 150
Brookshire, TX 77423
Phone (281) 717-4674
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner |
363L00000X | Yes |
Addresses
Primary practice location
30575 Kingsland Blvd # 150
Brookshire, TX 77423-2844
Mailing address
30575 Kingsland Blvd # 150
Brookshire, TX 77423-2844
Phone (281) 717-4674
Other names
- Athena medical clinic LLC
Other providers in Brookshire, TX
- Dunia Altameemi
- Shirley Adaeze Amanfo
- Latisha Renea Amos
- Anointed Hands Home Healthcare
- Apex Connect Integrative Medicine
- Athena Testosterone and Weight Loss PLLC
- Iolani Mae S Aves
- Penelope L Barahona Vega
- Adrianna Alexandra Barber
- Candezz Bell
All providers in Brookshire, TX · Nurse Practitioner in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.