MEDICARE: JAISY JOSE KANDANATTU APRN

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	AP127404	TX

General Provider Information

NPI Number	:	1669867180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAISY JOSE KANDANATTU APRN

Provider Business Mailing Address
First Line	:	250 BLOSSOM ST STE 120
Second Line	:
City	:	WEBSTER
State	:	TX
Zip	:	77598-4243
Country	:	US
Telephone Number	:	713-973-7246
Fax Number	:

Provider Business Practice Location Address
First Line	:	6410 FANNIN ST STE 1508
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-5306
Country	:	US
Telephone Number	:	713-486-6130
Fax Number	:

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

Provider Enumeration Date	:	04/01/2015
Last Update Date	:	12/18/2023

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