Provider Demographics
NPI:1083460216
Name:JOHN, SMITHA BIJU (PMHNP)
Entity type:Individual
Prefix:
First Name:SMITHA
Middle Name:BIJU
Last Name:JOHN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 EMBER BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1107
Mailing Address - Country:US
Mailing Address - Phone:864-208-6320
Mailing Address - Fax:
Practice Address - Street 1:201 OAK DR S STE 102
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5626
Practice Address - Country:US
Practice Address - Phone:979-529-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1156727363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health