MEDICARE: LINCOLN JESSE NASH SR.

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	172V00000X	Community Health Worker		TX
2	374U00000X	Home Health Aide		TX

General Provider Information

NPI Number	:	1427438142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINCOLN JESSE NASH SR.

Provider Business Mailing Address
First Line	:	13934 DENTWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-2667
Country	:	US
Telephone Number	:	832-528-7286
Fax Number	:

Provider Business Practice Location Address
First Line	:	13934 DENTWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-2667
Country	:	US
Telephone Number	:	832-528-7286
Fax Number	:

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

Provider Enumeration Date	:	06/08/2015
Last Update Date	:	06/08/2015

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