Healthcare Provider Details

I. General information

NPI: 1073236485
Provider Name (Legal Business Name): JENNIE KAY WORRELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18885 KATY FWY
HOUSTON TX
77094-1103
US

IV. Provider business mailing address

PO BOX 207
HOUSTON TX
77001-0207
US

V. Phone/Fax

Practice location:
  • Phone: 281-829-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA64790
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16353
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA16353
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: