St Marys Medi Spa LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

ST MARYS MEDI SPA LLC

Doing business as

St Marys Medi Spa

Practice address

4102 Fannin St
Houston, TX 77004-4808

Phone

(713) 524-2633

Fax

(713) 524-2639

NPI assigned

Jun 28, 2021

Organization subpart

No

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

Authorized official

Name

Jacqueline Watson, NURSE PRACTITIONERNPI 1467765081

Title

Provider

Phone

(713) 524-2633

Specialties & licenses 1

Addresses

Other names 1

• St Marys Medi Spa Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jacqueline Watson, ANP-C

  • Adult Health Nurse Practitioner
  • Houston, TX
  • NPI 1467765081
  NPD Authorized official

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

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624838400000",
    "number": "1841860327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4102 FANNIN ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770044808",
            "telephone_number": "713-524-2633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4102 FANNIN ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770044808",
            "telephone_number": "713-524-2633",
            "fax_number": "713-524-2639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARYS MEDI SPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-28",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "713-524-2633",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Marys Medi Spa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brandi Demouy St Marie, LPC
• St Mary's Behavioral Pain Management (Houston Medical Group)
• St Mary's Behavioral Pain Management
• St Mary's Healthcare Inc
• St Mary's Home Health LLC
• St Michael Healthcare Services, Inc.
• St Michael Medical Clinic P a
• St Michaels Center for Special Surgery LTD
• St Michaels Hospital & Healthcare Group LLC (St Michaels Hospital)
• St Michaels Labs Inc

• Clinic/Center in Houston, TX
• Providers in Houston, TX by specialty
• Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; 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.