Organization Name: | PREMIER PM PA |
NPI Number: | 1013304096 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JERRY PARSONS (DIRECTOR OF OPERATIONS) |
Mailing Address: | 2018 Broadway St Pearland |
State: | TX US |
Postal Code: | 775815502 |
Phone Number: | 2814852955 |
Fax Number: | |
NPI Enumeration Date: | 04/17/2015 |
NPI Last Update Date: | 04/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 717330 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |