Healthcare Provider Details

I. General information

NPI: 1881208213
Provider Name (Legal Business Name): JELENCIA JENAE MARION NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 09/02/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 FANNIN ST STE 555
HOUSTON TX
77030-2717
US

IV. Provider business mailing address

6550 FANNIN ST STE 555
HOUSTON TX
77030-2717
US

V. Phone/Fax

Practice location:
  • Phone: 713-441-1391
  • Fax: 713-441-7200
Mailing address:
  • Phone: 713-441-1391
  • Fax: 713-441-7200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1010294
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: