Provider Demographics
NPI:1811021249
Name:GRAHAM, JILLIAN S (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:S
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:17017 NANES DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2501
Mailing Address - Country:US
Mailing Address - Phone:281-587-0133
Mailing Address - Fax:281-587-0146
Practice Address - Street 1:17017 NANES DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2501
Practice Address - Country:US
Practice Address - Phone:281-587-0133
Practice Address - Fax:281-587-0146
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA04831363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical