Provider Demographics
NPI:1194109264
Name:GATES, TAESIA CONSTANCE (FNP-C, CPNP-AC)
Entity type:Individual
Prefix:MRS
First Name:TAESIA
Middle Name:CONSTANCE
Last Name:GATES
Suffix:
Gender:F
Credentials:FNP-C, CPNP-AC
Other - Prefix:
Other - First Name:TAESIA
Other - Middle Name:CONSTANCE
Other - Last Name:ALFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:6410 FANNIN ST STE 370
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18200 KATY FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1285
Practice Address - Country:US
Practice Address - Phone:832-227-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2022-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130974363LF0000X, 363LP0200X
FLARNP9304820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily