=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003609488
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACKQUEL ANESHIA COLLINS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2025
-----------------------------------------------------
Last Update Date | 11/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6006 THEALL RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77066-1403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-206-0134
-----------------------------------------------------
Fax | 713-955-5201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6006 THEALL RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77066-1403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-206-0134
-----------------------------------------------------
Fax | 713-955-5201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F05250056
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------