Provider Demographics
NPI:1811682768
Name:COFFEY, JACQUELINE SIM (CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:SIM
Last Name:COFFEY
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 COUNTY ROAD 203
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:TX
Mailing Address - Zip Code:77577-8920
Mailing Address - Country:US
Mailing Address - Phone:281-884-2811
Mailing Address - Fax:
Practice Address - Street 1:11914 ASTORIA BLVD STE 450
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6077
Practice Address - Country:US
Practice Address - Phone:281-484-7619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1118810363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics