Individual
JISHA TOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4000
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-6161
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
AP141184
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
405838001
—
TX
01
—
405838002
MEDICAID-CSHCN
TX
01
—
8LZ698
BCBS
TX
Enumeration date
10/09/2019
Last updated
02/10/2020
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