Healthcare Provider Details

I. General information

NPI: 1275382384
Provider Name (Legal Business Name): JADE HOSTETTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26010 OAK RIDGE DR STE 100
SPRING TX
77380-1972
US

IV. Provider business mailing address

PO BOX 797171
DALLAS TX
75379-7171
US

V. Phone/Fax

Practice location:
  • Phone: 281-245-0288
  • Fax: 281-245-0336
Mailing address:
  • Phone: 214-494-4424
  • Fax: 214-494-4423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberPA17844
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: