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General NPI Number Information
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NPI Number | 1871036202
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Entity Type | Individual
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Provider Name | SHOBHA JAGANNATH NP
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Gender | Female
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Dates
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Enumeration Date | 12/03/2016
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 14080C FARM TO MARKET 2920 E
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City | TOMBALL
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State | TX
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Zip | 77377
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Country | US
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Telephone | 832-843-7135
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Fax |
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Provider Business Mailing Address
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Address Line | 2723 SHADOW CANYON LN
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City | KATY
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State | TX
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Zip | 77494-2390
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Country | US
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Telephone | 713-614-3097
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP-03187
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP132630
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License Number State | TX
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