Provider Demographics
NPI:1124594213
Name:TOUSSOM, JEAN-MARIE
Entity Type:Individual
Prefix:
First Name:JEAN-MARIE
Middle Name:
Last Name:TOUSSOM
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 1:2475 S CHAPPELL HILL ST APT 1003
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-6124
Mailing Address - Country:US
Mailing Address - Phone:979-661-0209
Mailing Address - Fax:
Practice Address - Street 1:4030 HIGHWAY 6 S STE 150
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-1808
Practice Address - Country:US
Practice Address - Phone:979-431-3380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK131205163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health