Provider Demographics
NPI:1962840074
Name:JUST 4 KIDS PEDIATRICS LLP
Entity Type:Organization
Organization Name:JUST 4 KIDS PEDIATRICS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAINY
Authorized Official - Middle Name:BENNY
Authorized Official - Last Name:VARGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,RN,CPNP
Authorized Official - Phone:281-261-5800
Mailing Address - Street 1:2503 S MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5544
Mailing Address - Country:US
Mailing Address - Phone:281-261-5800
Mailing Address - Fax:281-261-5885
Practice Address - Street 1:2503 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5544
Practice Address - Country:US
Practice Address - Phone:281-261-5800
Practice Address - Fax:281-261-5885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX603668363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX537132OtherSTATE LICENCE
TX210617101Medicaid
TX603668OtherSTATE LICENSE