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1710254743 NPI number — SOWMYA MARIAM JOHN PA-C

NPI Number: 1710254743
Health Care Provider/Practitioner: SOWMYA MARIAM JOHN PA-C

Information about “1710254743” NPI (SOWMYA MARIAM JOHN PA-C) exists in 1710254743 in HTML format HTML  |  1710254743 in plain Text format TXT  |  1710254743 in PDF (Portable Document Format) PDF  |  1710254743 in an XML format XML  formats.

NPI Number : 1710254743 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710254743",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JOHN",
    "FirstName": "SOWMYA",
    "MiddleName": "MARIAM",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "OOMMEN",
    "OtherFirstName": "SOWMYA",
    "OtherMiddleName": "MARIAM",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PA-C",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1977 BUTLER BLVD STE E5.200",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HOUSTON",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77030-4101",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "713-873-2000",
    "MailingAddressFaxNumber": "713-798-5841",
    "FirstLinePracticeLocationAddress": "1502 TAUB LOOP",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOUSTON",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77030-1608",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "713-873-8890",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/18/2011",
    "LastUpdateDate": "11/13/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AS0400X",
          "TaxonomyName": "Surgical Physician Assistant",
          "LicenseNumber": "PA213049",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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