Provider Demographics
NPI:1912087255
Name:THEIS, JALANE S (CPNP)
Entity Type:Individual
Prefix:
First Name:JALANE
Middle Name:S
Last Name:THEIS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 WEST LOOP S STE 215
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-9082
Mailing Address - Country:US
Mailing Address - Phone:713-621-9515
Mailing Address - Fax:
Practice Address - Street 1:1001 WEST LOOP S STE 215
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-9082
Practice Address - Country:US
Practice Address - Phone:713-621-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC290289363L00000X
TX689594363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169122201Medicaid
NC1912087255Medicaid
SCNP4084Medicaid
Q28334Medicare UPIN
NC1912087255Medicaid
SCNP4084Medicaid