Provider Demographics
NPI:1558030866
Name:MERCY GATHOGO
Entity type:Organization
Organization Name:MERCY GATHOGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GATHOGO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:832-475-8787
Mailing Address - Street 1:27027 BARRINGTON LODGE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2725
Mailing Address - Country:US
Mailing Address - Phone:832-475-8787
Mailing Address - Fax:
Practice Address - Street 1:27027 BARRINGTON LODGE LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-2725
Practice Address - Country:US
Practice Address - Phone:832-475-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty