Provider Demographics
NPI:1851740930
Name:GHOUSE, AMRIEN (DO)
Entity type:Individual
Prefix:DR
First Name:AMRIEN
Middle Name:
Last Name:GHOUSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5762 GRANDSCAPE BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-6782
Mailing Address - Country:US
Mailing Address - Phone:469-647-9344
Mailing Address - Fax:
Practice Address - Street 1:5762 GRANDSCAPE BLVD STE 115
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-6782
Practice Address - Country:US
Practice Address - Phone:469-647-9344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU5107207Q00000X
OH34.015377207Q00000X
FLOS20732207Q00000X
CA20A23954207Q00000X
NY327386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.148576OtherILLINOIS MEDICAL LICENSE