Provider Demographics
NPI:1518698653
Name:ROYSTON, JALIYAH
Entity Type:Individual
Prefix:
First Name:JALIYAH
Middle Name:
Last Name:ROYSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 GROSS ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-1240
Mailing Address - Country:US
Mailing Address - Phone:409-749-7006
Mailing Address - Fax:
Practice Address - Street 1:9150 GROSS ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-1240
Practice Address - Country:US
Practice Address - Phone:409-749-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program