Provider Demographics
NPI:1467505032
Name:GRIGGS, JACQUELYN CHLO (CNM)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:CHLO
Last Name:GRIGGS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-3617
Mailing Address - Country:US
Mailing Address - Phone:713-505-1802
Mailing Address - Fax:888-473-1877
Practice Address - Street 1:637 W 20TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-3617
Practice Address - Country:US
Practice Address - Phone:713-505-1802
Practice Address - Fax:888-473-1877
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX601019367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1583718-01Medicaid
TX601019OtherAPN LICENSE #
TXP80209Medicare UPIN
TX00537Medicare ID - Type Unspecified