Healthcare Provider Details

I. General information

NPI: 1528490927
Provider Name (Legal Business Name): MALIKA ADAMS JEFFERSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 BERRY RD # T-1777
HOUSTON TX
77022-3209
US

IV. Provider business mailing address

PO BOX 66308
HOUSTON TX
77266-6308
US

V. Phone/Fax

Practice location:
  • Phone: 713-742-8151
  • Fax: 713-695-2629
Mailing address:
  • Phone: 713-967-8699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number718205
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberAP124142
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP124142
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: