Provider Demographics
NPI:1639847544
Name:UBOKUDOM, JESSIE E (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:E
Last Name:UBOKUDOM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10626 BELSHILL ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2115
Mailing Address - Country:US
Mailing Address - Phone:832-279-2058
Mailing Address - Fax:
Practice Address - Street 1:10626 BELSHILL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2115
Practice Address - Country:US
Practice Address - Phone:832-279-2058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF06210116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily