Provider Demographics
NPI:1174905384
Name:CUMMINGS, JUSTIN JAMES
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:JAMES
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 GRAHAM DRIVE
Mailing Address - Street 2:SUITE 290
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375
Mailing Address - Country:US
Mailing Address - Phone:281-357-1934
Mailing Address - Fax:281-357-1230
Practice Address - Street 1:506 GRAHAM DRIVE
Practice Address - Street 2:SUITE 290
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375
Practice Address - Country:US
Practice Address - Phone:281-357-1934
Practice Address - Fax:281-357-1230
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128197363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP128197OtherAPRN