Provider Demographics
NPI:1831499029
Name:JACOB, BLESSY S (NP)
Entity Type:Individual
Prefix:MRS
First Name:BLESSY
Middle Name:S
Last Name:JACOB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11230 AIRLINE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77037-1116
Mailing Address - Country:US
Mailing Address - Phone:832-810-9521
Mailing Address - Fax:855-703-1949
Practice Address - Street 1:11230 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77037-1116
Practice Address - Country:US
Practice Address - Phone:832-810-9521
Practice Address - Fax:855-703-1949
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119563363LA2200X, 363LP2300X
TX685775363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3153637Medicaid