Healthcare Provider Details

I. General information

NPI: 1376833673
Provider Name (Legal Business Name): KRYSTAL LYNN JERRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2944 MERIDIANA PKWY STE D
ROSHARON TX
77583-5565
US

IV. Provider business mailing address

2944 MERIDIANA PKWY STE D
ROSHARON TX
77583-5565
US

V. Phone/Fax

Practice location:
  • Phone: 346-692-9161
  • Fax: 346-692-9033
Mailing address:
  • Phone: 346-692-9161
  • Fax: 346-692-9033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP9207
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: