Provider Demographics
NPI:1871242925
Name:JOSE, JISHA MARY
Entity Type:Individual
Prefix:
First Name:JISHA
Middle Name:MARY
Last Name:JOSE
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 1:2627 CHESTNUT RIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1777
Mailing Address - Country:US
Mailing Address - Phone:281-358-1950
Mailing Address - Fax:281-358-1923
Practice Address - Street 1:2627 CHESTNUT RIDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1777
Practice Address - Country:US
Practice Address - Phone:281-358-1950
Practice Address - Fax:281-358-1923
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034498363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner