MEDICARE: JEMILAT MOMOH AGNP-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	363LA2200X	Adult Health Nurse Practitioner	AP135099	TX
2	363LG0600X	Gerontology Nurse Practitioner	AP135099	TX

General Provider Information

NPI Number	:	1700396082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEMILAT MOMOH AGNP-C

Provider Business Mailing Address
First Line	:	901 HIDDEN VALLEY DR APT 3105
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-1460
Country	:	US
Telephone Number	:	512-351-0142
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 CONGRESS AVE STE 1540
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-3851
Country	:	US
Telephone Number	:	512-937-9168
Fax Number	:

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

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	02/03/2026

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Directions to “ JEMILAT MOMOH AGNP-C” Practice Location

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