Medfast Pediatric & Family Clinic

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP128920 Issued in TX

Legal business name

MEDFAST PEDIATRIC & FAMILY CLINIC

Practice address

14520 Old Katy Rd, St 109
Houston, TX 77079

Phone

(832) 847-1527

NPI assigned

Sep 28, 2015

Organization subpart

No

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

Authorized official

Name

Olubunmi Olufunke Kazzim, FNP- C

Title

Director

Phone

(832) 847-1527

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1443398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443484800000",
    "number": "1942670401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14520 OLD KATY RD, ST 109",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77079",
            "telephone_number": "832-847-1527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14520 OLD KATY RD, ST 109",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77079",
            "telephone_number": "832-847-1527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDFAST PEDIATRIC & FAMILY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-28",
        "last_updated": "2015-09-29",
        "status": "A",
        "authorized_official_last_name": "KAZZIM",
        "authorized_official_first_name": "OLUBUNMI",
        "authorized_official_middle_name": "OLUFUNKE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "832-847-1527",
        "authorized_official_credential": "FNP- C"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP128920",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medflight International, Inc.
• Jessica Medford, NP-C
• Millicia Medford
• Medfund LLC
• Medfuse RX LLC

• Nurse Practitioner in Houston, TX
• Providers in Houston, TX by specialty
• Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2015; 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.