Provider Demographics
NPI:1568178226
Name:VASQUEZ, KEYRA E G (NNP-BC)
Entity type:Individual
Prefix:
First Name:KEYRA
Middle Name:E G
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:206 TRENT ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77905-5416
Mailing Address - Country:US
Mailing Address - Phone:361-894-1987
Mailing Address - Fax:
Practice Address - Street 1:6411 FANNIN ST STE MSB32.44
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-704-4000
Practice Address - Fax:713-704-5269
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1057826363LN0000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal