Provider Demographics
NPI:1669867180
Name:KANDANATTU, JAISY JOSE (APRN)
Entity type:Individual
Prefix:
First Name:JAISY
Middle Name:JOSE
Last Name:KANDANATTU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 BLOSSOM ST STE 120
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4243
Mailing Address - Country:US
Mailing Address - Phone:713-973-7246
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST STE 1508
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5306
Practice Address - Country:US
Practice Address - Phone:713-486-6130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily