Provider Demographics
NPI:1699135418
Name:MYERS, RADCLIFFE (FNP-BC)
Entity type:Individual
Prefix:
First Name:RADCLIFFE
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9715 DRY CREEK CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2084
Mailing Address - Country:US
Mailing Address - Phone:210-441-0851
Mailing Address - Fax:
Practice Address - Street 1:1201 S ALLEN GENOA RD
Practice Address - Street 2:
Practice Address - City:SOUTH HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77587-4464
Practice Address - Country:US
Practice Address - Phone:713-667-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129527363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily