Basic Information
Provider Information
NPI: 1790179042
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: NATHAN
MiddleName: SETH
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2 GREENWAY PLZ
Address2: SUITE 300
City: HOUSTON
State: TX
PostalCode: 770460297
CountryCode: US
TelephoneNumber: 8328283660
FaxNumber:  
Practice Location
Address1: 6701 FANNIN ST
Address2:  
City: HOUSTON
State: TX
PostalCode: 770302608
CountryCode: US
TelephoneNumber: 8328241000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/25/2015
LastUpdateDate: 06/28/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/28/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XAP128347TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 
367500000X765094TXN Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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