Provider Demographics
NPI:1548767197
Name:RAJU, JAISY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JAISY
Middle Name:
Last Name:RAJU
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JAISY
Other - Middle Name:
Other - Last Name:VARGHESE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:398 REDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-3239
Mailing Address - Country:US
Mailing Address - Phone:469-688-2065
Mailing Address - Fax:
Practice Address - Street 1:398 REDSTONE DR
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-3239
Practice Address - Country:US
Practice Address - Phone:469-688-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137265363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP137265OtherTEXAS BOARD OF NURSING