Provider Demographics
NPI:1710411616
Name:PERSEVERANCE HEATLH INNOVATION LTD
Entity type:Organization
Organization Name:PERSEVERANCE HEATLH INNOVATION LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIERSTEN
Authorized Official - Middle Name:CHANTELLE
Authorized Official - Last Name:WILLIAMS-BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-380-0216
Mailing Address - Street 1:24646 NORTH FREEWAY 45 N.
Mailing Address - Street 2:200
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386
Mailing Address - Country:US
Mailing Address - Phone:832-380-0216
Mailing Address - Fax:281-745-4367
Practice Address - Street 1:21706 WILLOW DOWNS
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375
Practice Address - Country:US
Practice Address - Phone:832-380-0216
Practice Address - Fax:281-745-4367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7983171W00000X
TX7397172V00000X
TX771216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No171W00000XOther Service ProvidersContractorGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty