NPIMap

Organization Active NPI

Clearlake Kids Psychiatry

  • Physician Assistant
  • Houston, TX
National Provider Identifier
1447708128
Registry record updated Sep 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA00473 Issued in TX
Legal business name
CLEARLAKE KIDS PSYCHIATRY
Practice address
17226 Mercury Dr
Suite 100
Houston, TX 77058-2792
Phone
(281) 975-0600
NPI assigned
Sep 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2017

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

Authorized official

Name
Jeanne Russell, PA-C
Title
Owner
Phone
(903) 918-3294

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X PA00473 TX Primary

Addresses

Primary practice location

17226 Mercury Dr
Suite 100
Houston, TX 77058-2792

Mailing address

17226 Mercury Dr
Suite 100
Houston, TX 77058-2792
Phone (281) 975-0600

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1473638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504569600000",
    "number": "1447708128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17226 MERCURY DR",
            "address_2": "SUITE 100",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770582792",
            "telephone_number": "281-975-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17226 MERCURY DR",
            "address_2": "SUITE 100",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770582792",
            "telephone_number": "281-975-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARLAKE KIDS PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-12",
        "last_updated": "2017-09-05",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "JEANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-918-3294",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA00473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.