MIJEONG PARK (NPI# 1710354907) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710354907 |
| Entity Type | Individual |
| Full Name | MIJEONG PARK |
| Credential | CPNP |
| Practice Address |
12015 Louetta Rd Ste 100 Houston TX 77070-1148 |
| Mailing Address |
27721 State Highway 249 Ste 100 Tomball TX 77375-6579 |
| Practice Telephone | 2816642152 |
| Practice Fax Number | 2812573514 |
| Mailing Telephone | 2813575115 |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2019-06-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
AP135474 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
5007911 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | DOCTORS DIRECT | 1710354907 | 01 |
| NC | BCBS OF NC | 19EFK | 01 |
| NC | COVENTRY OF THE CAROLINAS | 1579732 | 01 |
| NC | AETNA | 4948746 | 01 |
| NC | WELLPATH | 1579732 | 01 |
| NC | HEALTHSMART | 1710354907 | 01 |
| TX | 1710354907 | 05 | |
| NC | UNITED HEALTHCARE | 5707800 | 01 |
| NC | HUMANA | 1710354907 | 01 |
| NC | MEDCOST | 298447 | 01 |
| NC | COVENTRY NATIONAL - COVENTRY PPO | 4632274 | 01 |
| NC | 1710354907 | 05 | |
| NC | HEALTHNET FEDERAL SERVICES | 1710354907 | 01 |
| NC | CIGNA/GREATWEST | 3455644 | 01 |
| NC | FIRST CAROLINA CARE | FH4002315 | 01 |
| NC | PHCS/MULTIPLAN | 135452367 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1271 Oliver St, Fayetteville, NC 283044450 | 9103234281 | 9103232842 |
| Street Address |
12015 LOUETTA RD STE 100 |
| City | HOUSTON |
| State | TX |
| Zip Code | 77070-1148 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083752059 | Pediatric Healthcare of Northwest Houston Pa | Family Medicine | 12015 Louetta Rd Ste 100, Houston, TX 77070-1148 | 2007-02-02 |
| 1851937783 | Valeria Niculae | Nurse Practitioner | 12015 Louetta Rd Ste 100, Houston, TX 77070-1148 | 2019-11-26 |
| 1447372123 | Pediatric Healthcare of Northwest Houston Pa | Pediatrics | 12015 Louetta Rd Ste 100, Houston, TX 77070-1148 | 2007-04-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356962666 | Polyanna De La Garza Optometrist Pllc | Optometrist | 22438 Tomball Parkway, Houston, TX 77070 | 2020-04-28 |
| 1871113837 | Carolyn Hong Nguyen | Radiology | 18220 Tx 249, Houston, TX 77070 | 2020-04-20 |
| 1942831268 | Rea May Roque Danao | Registered Nurse | 18220 Tx-249, Houston, TX 77070 | 2020-01-27 |
| 1124669866 | Endocrine Diabetes and Thyroid Specialists of Houston Pllc | Internal Medicine | 18220 Texas 249 Access Rd, Houston, TX 77070 | 2019-10-03 |
| 1851944300 | Oculus Cypresswood, LLC | Optometrist | Hwy 249 & Cypresswood, Houston, TX 77070 | 2019-07-23 |
| 1740832310 | Oculus Cypresswood, LLC | Optometrist | Highway 249 & Cypresswood, Houston, TX 77070 | 2019-07-12 |
| 1750846176 | Karen Fletcher | Occupational Therapy Assistant | Silverado Vintage Preserve, 10120 Louette Rd, Houston, TX 77070 | 2019-02-11 |
| 1154803518 | Geraldine Santillan Villanueva | Physical Therapist | 13220 Breton Ridge St., Houston, TX 77070 | 2018-09-02 |
| 1467945865 | Pure G Kids, LLC | Clinic/Center | 21175 Tomball Pkwy Ste 379, Houston, TX 77070 | 2018-06-11 |
| 1063902518 | Stephanie Leona Bloodworth | Marriage & Family Therapist | 9950 Cypresswood Dr Ste 214, Houston, TX 77070 | 2018-05-10 |
| Find all providers in zip 77070 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184266538 | Kristen Nicole Herzog | Nurse Practitioner | 1644 W 13th St, Houston, TX 77008-6451 | 2019-10-16 |
| 1023667185 | Kristin Becker | Nurse Practitioner | 18200 Katy Fwy Ste Wd200, Houston, TX 77094-1399 | 2019-09-10 |
| 1740763721 | Emily Christopherson Shushtari | Nurse Practitioner | 1619 Scenic Ridge Dr, Houston, TX 77043-3408 | 2018-09-14 |
| 1619454097 | Debbie Raucci Robbins | Nurse Practitioner | 3845 Cypress Creek Pkwy Ste 180, Houston, TX 77068-3532 | 2018-07-27 |
| 1063901627 | Tonya Barnett | Nurse Practitioner | 15555 Kuykendahl Rd Fl 3, Houston, TX 77090-3651 | 2018-05-08 |
| 1619342565 | Ritika Tina Dewan | Nurse Practitioner | 6621 Fannin St Fl 1, Houston, TX 77030-2358 | 2015-12-03 |
| 1467858175 | Jessica Marie Ginn | Nurse Practitioner | 8329 Lawndale St, Houston, TX 77012-3707 | 2014-11-06 |
| 1629492277 | Mackenzie Clotworthy | Nurse Practitioner | 4211 Watonga Blvd, Houston, TX 77092-5324 | 2014-02-18 |
| 1477875037 | Hiji Geneva Washington | Nurse Practitioner | 5410 N Braeswood Blvd Apt 912, Houston, TX 77096-3251 | 2010-02-24 |
| 1124355052 | Susan Cooley King | Nurse Practitioner | 9 Greenway Plaza, Suite 2950, Houston, TX 77046 | 2009-11-13 |
| Find all providers in HOUSTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.