Healthcare Provider Details

I. General information

NPI: 1043602378
Provider Name (Legal Business Name): JYOTHI MEPPARAMABTH NP-ADULT & GERIATRIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W MEDICAL CENTER BLVD
WEBSTER TX
77598-4234
US

IV. Provider business mailing address

450 W MEDICAL CENTER BLVD
WEBSTER TX
77598-4234
US

V. Phone/Fax

Practice location:
  • Phone: 281-332-2525
  • Fax: 281-554-7403
Mailing address:
  • Phone: 281-332-2525
  • Fax: 281-554-7403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP127501
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP127501
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: