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General NPI Number Information
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NPI Number | 1285529982
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Entity Type | Individual
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Provider Name | JAYA PHILIP AGACNP
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Gender | Female
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | UTMB HEALTH CLEAR LAKE CAMPUS HOSPITAL 200 BLOSSOM STREET
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City | WEBSTER
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State | TX
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Zip | 77598
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Country | US
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Telephone | 832-632-6500
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Fax | 281-557-7284
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Provider Business Mailing Address
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Address Line | 1307 W LEAGUE CITY PKWY
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City | LEAGUE CITY
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State | TX
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Zip | 77573-6313
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Country | US
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Telephone | 281-813-2134
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Fax | 281-332-7272
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1069897
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License Number State | TX
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