MEDICARE: DR. JESSICA NU GLICK D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	BP10057687	TX
2	207Q00000X	Family Medicine Physician	R4228	TX

General Provider Information

NPI Number	:	1114375227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA NU GLICK D.O.

Provider Business Mailing Address
First Line	:	8584 KATY FWY STE 210
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1880
Country	:	US
Telephone Number	:	713-280-7991
Fax Number	:	713-904-3071

Provider Business Practice Location Address
First Line	:	8584 KATY FWY STE 210
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1880
Country	:	US
Telephone Number	:	713-280-7991
Fax Number	:	713-904-3071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2016
Last Update Date	:	04/14/2025

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