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General NPI Number Information
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NPI Number | 1619511276
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Entity Type | Individual
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Provider Name | JAMES MATHEW KALLICKAL ACAGNP
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Gender | Male
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Dates
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Enumeration Date | 11/06/2019
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Last Update Date | 11/06/2019
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Provider Practice Location Address
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Address Line | 3406 BUSINESS CENTER DR
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City | PEARLAND
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State | TX
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Zip | 77584-4148
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Country | US
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Telephone | 346-570-2284
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Fax |
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Provider Business Mailing Address
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Address Line | 1118 CONCORD PL
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City | MISSOURI CITY
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State | TX
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Zip | 77459-6770
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Country | US
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Telephone | 832-263-0962
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Fax |
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AP142979
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | AP142979
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License Number State | TX
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