Provider Demographics
NPI:1275715468
Name:PRECISE MID-LEVEL PROVIDER SERVICES OF HOUSTON, PLLC
Entity Type:Organization
Organization Name:PRECISE MID-LEVEL PROVIDER SERVICES OF HOUSTON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:832-878-5352
Mailing Address - Street 1:5811 CYPRESSWICK CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7996
Mailing Address - Country:US
Mailing Address - Phone:832-878-5352
Mailing Address - Fax:281-257-0422
Practice Address - Street 1:5811 CYPRESSWICK CIR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7996
Practice Address - Country:US
Practice Address - Phone:832-878-5352
Practice Address - Fax:281-257-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX624607363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275560153OtherNPI