Basic Information
| Provider Information | |||||||||
| NPI: | 1972260875 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NYAENYA | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14106 SPRING BIRCH LN | ||||||||
| Address2: | |||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775844223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8322070646 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4828 LOOP CENTRAL DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770812212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139793800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2021 | ||||||||
| LastUpdateDate: | 11/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 1021456 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 2019074632 | 01 | ANCC | OTHER |