MEDICARE: MR. KENYON JERMON ISAACS SR. FNP

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	363LF0000X	Family Nurse Practitioner	AP135673	TX

General Provider Information

NPI Number	:	1588178610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENYON JERMON ISAACS SR. FNP

Provider Business Mailing Address
First Line	:	2150 W. 18TH STREET
Second Line	:	SUITE 300
City	:	HOUSTON
State	:	TX
Zip	:	77008
Country	:	US
Telephone Number	:	713-426-0027
Fax Number	:	713-426-0211

Provider Business Practice Location Address
First Line	:	1615 HILLENDAHL BLVD STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-3402
Country	:	US
Telephone Number	:	713-462-6565
Fax Number	:	713-426-0211

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

Provider Enumeration Date	:	11/28/2017
Last Update Date	:	05/18/2022

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