Provider Demographics
NPI:1467692798
Name:SIMONICH, JEAN (PA-C)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:SIMONICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18300 KATY FWY STE 565
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1536
Mailing Address - Country:US
Mailing Address - Phone:281-717-4003
Mailing Address - Fax:281-206-7597
Practice Address - Street 1:18300 KATY FWY STE 565
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1536
Practice Address - Country:US
Practice Address - Phone:281-717-4003
Practice Address - Fax:281-206-7597
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201750101Medicaid
TX8L9906Medicare PIN