Provider Demographics
NPI:1699255521
Name:PARDUE, KORIE SHANNONETTE (LVN)
Entity type:Individual
Prefix:MISS
First Name:KORIE
Middle Name:SHANNONETTE
Last Name:PARDUE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9310 HEATHERSIDE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77016-4604
Mailing Address - Country:US
Mailing Address - Phone:713-702-1913
Mailing Address - Fax:
Practice Address - Street 1:9310 HEATHERSIDE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77016-4604
Practice Address - Country:US
Practice Address - Phone:713-702-1913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX187675164W00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical Nurse