Individual
JOHN A MCDIVITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
10705 SPRING GREEN BLVD, STE. 200, HOUSTON, TX 77096-1605
(281) 783-8162
Mailing address
16107 KENSINGTON DR STE 126, SUGAR LAND, TX 77479-4224
(281) 783-8162
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP111300
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8N7490
BLUE CROSS & BLUE SHIELD
TX
Enumeration date
10/18/2006
Last updated
11/06/2019
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