Provider Demographics
NPI:1205478724
Name:MATHEW, JISHA (APRN)
Entity type:Individual
Prefix:MRS
First Name:JISHA
Middle Name:
Last Name:MATHEW
Suffix:
Gender:
Credentials:APRN
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 57845
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7845
Mailing Address - Country:US
Mailing Address - Phone:281-538-8188
Mailing Address - Fax:281-538-8189
Practice Address - Street 1:2911 S SHORE BLVD STE 190
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3919
Practice Address - Country:US
Practice Address - Phone:281-538-8188
Practice Address - Fax:281-538-8189
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1121908363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily