Healthcare Provider Details

I. General information

NPI: 1710233556
Provider Name (Legal Business Name): JPMK ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 BELLAIRE BLVD SUITE GG
HOUSTON TX
77025-1166
US

IV. Provider business mailing address

4007 BELLAIRE BLVD SUITE GG
HOUSTON TX
77025-1166
US

V. Phone/Fax

Practice location:
  • Phone: 281-723-3924
  • Fax: 713-667-5420
Mailing address:
  • Phone: 281-723-3924
  • Fax: 713-667-5420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number613434
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number613434
License Number StateTX

VIII. Authorized Official

Name: MS. PENNY MARIE WARNER
Title or Position: PRESIDENT/CEO/OWNER
Credential: RN
Phone: 281-723-3924