MEDICARE: JAMIE JATERRA PHILLIPS MEDICAL ASSISTANT

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	246RP1900X	Phlebotomy Technician		TX

General Provider Information

NPI Number	:	1558050419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE JATERRA PHILLIPS MEDICAL ASSISTANT

Provider Business Mailing Address
First Line	:	2213 N FRAZIER ST APT 801
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77303-1795
Country	:	US
Telephone Number	:	936-499-5349
Fax Number	:

Provider Business Practice Location Address
First Line	:	2213 N FRAZIER ST APT 801
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77303-1795
Country	:	US
Telephone Number	:	936-499-5349
Fax Number	:

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

Provider Enumeration Date	:	05/04/2023
Last Update Date	:	05/04/2023

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