Basic Information
| Provider Information | |||||||||
| NPI: | 1568906873 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OUTCOMES ALLIANCE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2801 VENETO CT | ||||||||
| Address2: | |||||||||
| City: | LEAGUE CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775735006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8327244283 | ||||||||
| FaxNumber: | 8322003636 | ||||||||
| Practice Location | |||||||||
| Address1: | 2801 VENETO CT | ||||||||
| Address2: | |||||||||
| City: | LEAGUE CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775735006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8327244283 | ||||||||
| FaxNumber: | 8322003636 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2016 | ||||||||
| LastUpdateDate: | 12/06/2016 | ||||||||
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| AuthorizedOfficialLastName: | WYNN VELA | ||||||||
| AuthorizedOfficialFirstName: | MICA | ||||||||
| AuthorizedOfficialMiddleName: | MALEIGH | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER, OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8327244283 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | FNP-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP122501 | TX | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.