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General NPI Number Information
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NPI Number | 1811682768
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Entity Type | Individual
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Provider Name | JACQUELINE SIM COFFEY CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 04/06/2023
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 11914 ASTORIA BLVD STE 450
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City | HOUSTON
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State | TX
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Zip | 77089-6077
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Country | US
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Telephone | 281-484-7619
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Fax |
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Provider Business Mailing Address
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Address Line | 4302 COUNTY ROAD 203
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City | LIVERPOOL
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State | TX
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Zip | 77577-8920
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Country | US
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Telephone | 281-884-2811
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 1118810
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License Number State | TX
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