MEDICARE: TYWANNA JEMISON II

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	164W00000X	Licensed Practical Nurse	213996	TX

General Provider Information

NPI Number	:	1245731629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYWANNA JEMISON II

Provider Business Mailing Address
First Line	:	3747 VARLA LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-2721
Country	:	US
Telephone Number	:	832-576-0127
Fax Number	:

Provider Business Practice Location Address
First Line	:	3747 VARLA LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-2721
Country	:	US
Telephone Number	:	832-576-0127
Fax Number	:

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

Provider Enumeration Date	:	02/22/2018
Last Update Date	:	02/22/2026

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