MEDICARE: MRS. MALIKA ADAMS JEFFERSON FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	718205	TX
2	363LS0200X	School Nurse Practitioner	AP124142	TX
3	363LF0000X	Family Nurse Practitioner	AP124142	TX

General Provider Information

NPI Number	:	1528490927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MALIKA ADAMS JEFFERSON FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 66308
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77266-6308
Country	:	US
Telephone Number	:	713-967-8699
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 BERRY RD # T-1777
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3209
Country	:	US
Telephone Number	:	713-742-8151
Fax Number	:	713-695-2629

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	10/10/2024

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