Healthcare Provider Details

I. General information

NPI: 1952811655
Provider Name (Legal Business Name): ABIGAYLE JORGENSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2017
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 FANNIN ST STE 1842
HOUSTON TX
77030
US

IV. Provider business mailing address

6560 FANNIN ST STE 1842
HOUSTON TX
77030-2715
US

V. Phone/Fax

Practice location:
  • Phone: 713-790-2089
  • Fax: 713-794-0576
Mailing address:
  • Phone: 713-790-2089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-14214
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA11548
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: