Healthcare Provider Details

I. General information

NPI: 1720898034
Provider Name (Legal Business Name): PRIMARY STEPS PEDIATRIC CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2025
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 Number
License Number State

VIII. Authorized Official

Name: DR. KRYSTAL LYNN JERRY
Title or Position: PHYSICIAN / OWNER
Credential: MD
Phone: 832-573-0755