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General NPI Number Information
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NPI Number | 1700396082
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Entity Type | Individual
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Provider Name | JEMILAT MOMOH AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 401 CONGRESS AVE STE 1540
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City | AUSTIN
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State | TX
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Zip | 78701-3851
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Country | US
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Telephone | 512-937-9168
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Fax |
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Provider Business Mailing Address
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Address Line | 901 HIDDEN VALLEY DR APT 3105
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City | ROUND ROCK
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State | TX
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Zip | 78665-1460
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Country | US
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Telephone | 512-351-0142
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP135099
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AP135099
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License Number State | TX
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