Provider Demographics
NPI:1700396082
Name:MOMOH, JEMILAT N/A (AGNP-C)
Entity Type:Individual
Prefix:
First Name:JEMILAT
Middle Name:N/A
Last Name:MOMOH
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 HIDDEN VALLEY DR APT 3105
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1460
Mailing Address - Country:US
Mailing Address - Phone:512-351-0142
Mailing Address - Fax:
Practice Address - Street 1:401 CONGRESS AVE STE 1540
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-3851
Practice Address - Country:US
Practice Address - Phone:512-937-9168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135099363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health