Provider Demographics
NPI:1144502410
Name:PRIESTLEY, KIAWANA NASHAE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KIAWANA
Middle Name:NASHAE
Last Name:PRIESTLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:KIAWANA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1101 W MAIN ST STE F
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2039
Mailing Address - Country:US
Mailing Address - Phone:281-849-7979
Mailing Address - Fax:346-202-0096
Practice Address - Street 1:1101 W MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2039
Practice Address - Country:US
Practice Address - Phone:281-849-7979
Practice Address - Fax:346-202-0096
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX729290363LF0000X
TXAP120739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX358558001Medicaid