1326386145 NPI number — MS. JESSICA LYNN HANSON PA-C

Table of content: MS. JESSICA LYNN HANSON PA-C (NPI 1326386145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326386145 NPI number — MS. JESSICA LYNN HANSON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSON
Provider First Name:
JESSICA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1326386145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6400 FANNIN ST
Provider Second Line Business Mailing Address:
SUITE 2070
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030-1521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-704-6731
Provider Business Mailing Address Fax Number:
713-704-1796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4141 VISTA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77504-2113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-947-3100
Provider Business Practice Location Address Fax Number:
713-947-6103
Provider Enumeration Date:
01/29/2013

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: 363A00000X , with the licence number:  PA08088 , 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)

  • Identifier: 0035TD . This is a "BCBSTX GRP RECORD NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DB6392 . This is a "GRP RAILROAD MDCR PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 153449704 . This is a "HARRIS COUNTY GRP TPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 302679101 . This is a "BRAZORIA COUNTY GRP TPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00106W . This is a "HARRIS COUNTY GRP MDCR PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00X185 . This is a "BRAZORIA COUNTY GRP PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 274019YNBT . This is a "MEDICARE PTAN FOR HARRIS CO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 274019YPXV . This is a "MEDICARE PTAN FOR BRAZORIA CO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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