Provider Demographics
NPI:1720859069
Name:DE SILVA, JAMIE MACKENZIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MACKENZIE
Last Name:DE SILVA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:MACKENZIE
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:714 TURNER COVE CT
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-2221
Mailing Address - Country:US
Mailing Address - Phone:713-252-8960
Mailing Address - Fax:
Practice Address - Street 1:13018 WOODFOREST BLVD STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-2775
Practice Address - Country:US
Practice Address - Phone:713-453-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1152228363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily