Provider Demographics
NPI:1912198805
Name:PHILIP, JESSY SABU (ANP)
Entity Type:Individual
Prefix:
First Name:JESSY
Middle Name:SABU
Last Name:PHILIP
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3345
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77253-3345
Mailing Address - Country:US
Mailing Address - Phone:713-796-9955
Mailing Address - Fax:
Practice Address - Street 1:8307 KNIGHT RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:713-796-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX685688363L00000X
TXAP116034363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187942101Medicaid
TX8K0719Medicare PIN
TX8J9257Medicare PIN
TXTXB111826Medicare PIN
TXP00738123Medicare PIN