=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376425355
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOLYN NMI PIATT NURSE PRACTITIONER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2025
-----------------------------------------------------
Last Update Date | 12/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2510 S LOOP 336 W STE 115
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77304-3737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-235-2825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8714 SUNSET HEIGHTS LN
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77302-3436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-378-4792
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 1207297
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------