Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 464080 | TX |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 464080 | TX |
NPI | 1306279583 |
---|---|
Provider Name | Jamie Jean Mckissick |
First Address | Houston, TX 77046-0207 |
Second Address | Houston, TX 77030-2608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2013 |
Last Update Date | 08/03/2017 |