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General NPI Number Information
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NPI Number | 1487933800
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Entity Type | Organization
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Legal Business Name | THE NEIGHBORHOOD CLINIC PLLC
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Dates
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Enumeration Date | 08/16/2011
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Last Update Date | 08/16/2011
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Provider Practice Location Address
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Address Line | 9910 FUQUA ST SUITE G
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City | HOUSTON
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State | TX
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Zip | 77075-5169
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Country | US
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Telephone | 713-496-0564
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Fax |
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Provider Business Mailing Address
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Address Line | 9910 FUQUA ST SUITE G
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City | HOUSTON
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State | TX
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Zip | 77075-5169
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Country | US
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Telephone | 713-496-0564
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACQUELINE ALLEN JESSIE
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Credential | RN, FNP
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Telephone | 281-248-1383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 647853
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License Number State | TX
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