Provider Demographics
NPI:1073784450
Name:JELKS, RACHEL MARIE (LVN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:JELKS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 PRUITT RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3024
Mailing Address - Country:US
Mailing Address - Phone:713-865-0254
Mailing Address - Fax:866-434-1073
Practice Address - Street 1:1029 PRUITT RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-3024
Practice Address - Country:US
Practice Address - Phone:713-865-0254
Practice Address - Fax:866-434-1073
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX187911164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001008854Medicaid