Provider Demographics
NPI:1972988319
Name:WASHINGTON, EBONY PATRICE (APRN)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:PATRICE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11329 N SAM HOUSTON PKWY E
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-4598
Mailing Address - Country:US
Mailing Address - Phone:318-461-1461
Mailing Address - Fax:
Practice Address - Street 1:11329 N SAM HOUSTON PKWY E
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4598
Practice Address - Country:US
Practice Address - Phone:281-835-4449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2022-04-27
Deactivation Date:2018-07-27
Deactivation Code:
Reactivation Date:2018-08-13
Provider Licenses
StateLicense IDTaxonomies
TX876657363LF0000X
TXAP128616363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily