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1164226502 NPI number — JACQUELYN CELESTE CASTILLO AGACNP-BC

NPI Number: 1164226502
Health Care Provider/Practitioner: JACQUELYN CELESTE CASTILLO AGACNP-BC

Information about “1164226502” NPI (JACQUELYN CELESTE CASTILLO AGACNP-BC) exists in 1164226502 in HTML format HTML  |  1164226502 in plain Text format TXT  |  1164226502 in PDF (Portable Document Format) PDF  |  1164226502 in an XML format XML  formats.

NPI Number : 1164226502 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164226502",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CASTILLO",
    "FirstName": "JACQUELYN",
    "MiddleName": "CELESTE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "AGACNP-BC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1110 PALESTINE ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTH HOUSTON",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77587-3413",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "281-740-5106",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6411 FANNIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOUSTON",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77030-1501",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "713-704-4000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/03/2025",
    "LastUpdateDate": "04/14/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207RC0200X",
          "TaxonomyName": "Critical Care Medicine (Internal Medicine) Physician",
          "LicenseNumber": "1194503",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "363LA2100X",
          "TaxonomyName": "Acute Care Nurse Practitioner",
          "LicenseNumber": "1194503",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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