Provider Demographics
NPI:1164425195
Name:JARBATH, MARIE DENISE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:DENISE
Last Name:JARBATH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17448 HIGHWAY 3
Mailing Address - Street 2:STE 136
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4141
Mailing Address - Country:US
Mailing Address - Phone:281-338-4443
Mailing Address - Fax:281-338-8821
Practice Address - Street 1:17448 HIGHWAY 3
Practice Address - Street 2:STE 136
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4141
Practice Address - Country:US
Practice Address - Phone:281-338-4443
Practice Address - Fax:281-338-8821
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02214363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82N265Medicare ID - Type Unspecified