Provider Demographics
NPI:1326049966
Name:CUNNINGHAM, JAYKAY (PA)
Entity Type:Individual
Prefix:
First Name:JAYKAY
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 FM 1092 RD
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2209
Mailing Address - Country:US
Mailing Address - Phone:281-403-8271
Mailing Address - Fax:281-403-8274
Practice Address - Street 1:1211 HIGHWAY 6
Practice Address - Street 2:SUITE 1
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4941
Practice Address - Country:US
Practice Address - Phone:281-494-4832
Practice Address - Fax:281-494-7399
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02518363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C2111Medicare ID - Type Unspecified
TXQ22596Medicare UPIN