Healthcare Provider Details

I. General information

NPI: 1235521725
Provider Name (Legal Business Name): JESSICA BAILEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 SAWDUST RD
SPRING TX
77380-2272
US

IV. Provider business mailing address

14914 JULIE MEADOWS LN
HUMBLE TX
77396-4683
US

V. Phone/Fax

Practice location:
  • Phone: 281-419-3162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP127471
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: