Provider Demographics
NPI:1033589882
Name:WASHINGTON, JEZREEL
Entity Type:Individual
Prefix:MR
First Name:JEZREEL
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1256
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77588-1256
Mailing Address - Country:US
Mailing Address - Phone:281-508-0739
Mailing Address - Fax:713-987-9199
Practice Address - Street 1:721 ANGELINA ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-1566
Practice Address - Country:US
Practice Address - Phone:337-254-1288
Practice Address - Fax:713-987-9199
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2022-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
3747A0650X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No251E00000XAgenciesHome Health
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1184089138OtherPERSONAL CARE ATTENDANT
TX1033589882OtherPERSONAL CARE ATTENDANT