Provider Demographics
NPI:1962067017
Name:SINGLETARY, JESSICA RENEE'
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE'
Last Name:SINGLETARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 VICTORY DR APT 1305
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-7241
Mailing Address - Country:US
Mailing Address - Phone:832-301-2394
Mailing Address - Fax:
Practice Address - Street 1:4444 VICTORY DR APT 1305
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-7241
Practice Address - Country:US
Practice Address - Phone:832-301-2394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX08998128OtherTEXAS DRIVER LICENSE