Provider Demographics
NPI:1912087255
Name:THEIS, JALANE S (APRN, CPNP-PC, PMHNP)
Entity type:Individual
Prefix:
First Name:JALANE
Middle Name:S
Last Name:THEIS
Suffix:
Gender:F
Credentials:APRN, CPNP-PC, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 TIMBERLOCH PL STE 500
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1375
Mailing Address - Country:US
Mailing Address - Phone:602-919-9932
Mailing Address - Fax:
Practice Address - Street 1:1100 W 23RD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-4682
Practice Address - Country:US
Practice Address - Phone:602-919-9932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC290289363L00000X
TX689594363L00000X
TXAP113229363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1912087255Medicaid
TX169122201Medicaid
SCNP4084Medicaid
Q28334Medicare UPIN
NC1912087255Medicaid
SCNP4084Medicaid