1295557882 NPI number — JESSICA BOWEN NUNEZ MA, LPA-IP

Table of content: JESSICA BOWEN NUNEZ MA, LPA-IP (NPI 1295557882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295557882 NPI number — JESSICA BOWEN NUNEZ MA, LPA-IP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NUNEZ
Provider First Name:
JESSICA
Provider Middle Name:
BOWEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPA-IP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295557882
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14311 WILDWOOD SPRINGS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77044-5471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-225-9352
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26010 OAK RIDGE DR STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THE WOODLANDS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77380-1972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-815-0899
Provider Business Practice Location Address Fax Number:
281-528-1107
Provider Enumeration Date:
10/25/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  38411 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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