Healthcare Provider Details

I. General information

NPI: 1033589882
Provider Name (Legal Business Name): MR. JEZREEL WASHINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 ANGELINA ST
WEBSTER TX
77598-1566
US

IV. Provider business mailing address

PO BOX 1256
PEARLAND TX
77588-1256
US

V. Phone/Fax

Practice location:
  • Phone: 337-254-1288
  • Fax: 713-987-9199
Mailing address:
  • Phone: 281-508-0739
  • Fax: 713-987-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number017457
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number017457
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number017457
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: