Individual provider Active NPI

Jayna Patel, ACNPC-AG

  • Nurse Practitioner
  • Houston, TX
National Provider Identifier
1043726862
Registry record updated Jun 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP134548 Issued in TX
Practice address
6624 Fannin St FL 19
Houston, TX 77030-2312
Phone
(713) 442-0000
NPI assigned
Dec 15, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP134548 TX Primary
Registered Nurse 163W00000X 833237 TX

Addresses

Primary practice location

6624 Fannin St FL 19
Houston, TX 77030-2312

Mailing address

11511 Shadow Creek Pkwy
Pearland, TX 77584-7298
Phone (713) 442-0000

Other identifiers 1

IdentifierTypeStateIssuer
381092101MedicaidTX

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jpatel24145@direct.kelsey-seybold.com Direct
FHIR URL https://ssrx.ksnet.com/FhirProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180111002079 TX Practitioner - Nurse Practitioner 3678832946 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP134548TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kelsey-Seybold Medical Group, PLLC CurrentSince Jan 22, 2018 Accepting new patients
Ipc Pac Healthcare Services of Texas PLLC Nurse Practitioner CurrentSince Dec 19, 2022 Accepting new patients
CS Pacs 3 Southwest, LLC CurrentSince Sep 9, 2024 Accepting new patients
NV Pacs 2 LLC CurrentSince Dec 19, 2022 Accepting new patients

Locations

999 Raintree Cir
Allen, TX 75013
Phone (972) 390-8088

5400 Clearfork Main St
Fort Worth, TX 76109
Phone (817) 433-7000

201 Sycamore School Rd
#R
Fort Worth, TX 76134
Phone (817) 293-7610

6301 Oakmont Blvd
Ft Worth, TX 76132
Phone (682) 250-4055

415 Indian Oaks Dr
Harker Hts, TX 76548
Phone (254) 699-5051

721 W Mulberry St
Holiday Lakes, TX 77515
Phone (979) 848-0279

6624 Fannin St
Fl 19
Houston, TX 77030

2727 W Holcombe Blvd
Houston, TX 77025
Phone (713) 790-9412

9250 Humble Westfield Rd
Humble, TX 77338
Phone (281) 418-9371

2101 W Northgate Dr
Irving, TX 75062
Phone (972) 255-4460

208 S Utah St
La Porte, TX 77571
Phone (281) 471-1810

811 Garner Rd
Pasadena, TX 77502
Phone (713) 473-8573

11511 Shadow Creek Pkwy
Pearland, TX 77584
Phone (713) 442-4997

6211 S New Braunfels Ave
#T
San Antonio, TX 78223
Phone (210) 531-0569

424 Tarpey Rd
#C
Texas City, TX 77591
Phone (409) 938-8431

Interoperability endpoints

  • Direct secure messaging: jpatel24145@direct.kelsey-seybold.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1513296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1043726862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11511 SHADOW CREEK PKWY",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775847298",
            "telephone_number": "713-442-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6624 FANNIN ST FL 19",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302312",
            "telephone_number": "713-442-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "JAYNA",
        "credential": "ACNPC-AG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-15",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP134548",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "833237",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "381092101",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpatel24145@direct.kelsey-seybold.com",
            "affiliation": "N",
            "endpointDescription": "digital contact information",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6624 Fannin St Fl 19",
            "city": "Houston",
            "state": "TX",
            "country_code": "US",
            "postal_code": "770302312",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://ssrx.ksnet.com/FhirProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FHIR endpoint URL",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6624 Fannin St Fl 19",
            "city": "Houston",
            "state": "TX",
            "country_code": "US",
            "postal_code": "770302312",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.