Provider Demographics
NPI:1588908594
Name:ANYALEBECHI, AGNES C (NP)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:C
Last Name:ANYALEBECHI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 SHAVER ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2603
Mailing Address - Country:US
Mailing Address - Phone:832-804-7094
Mailing Address - Fax:832-831-1128
Practice Address - Street 1:3909 SHAVER ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2603
Practice Address - Country:US
Practice Address - Phone:832-804-7094
Practice Address - Fax:832-831-1128
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121728363LF0000X
TX00196174364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341772701Medicaid
TX341771901Medicaid