Provider Demographics
NPI:1285529982
Name:PHILIP, JAYA (AGACNP)
Entity type:Individual
Prefix:
First Name:JAYA
Middle Name:
Last Name:PHILIP
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 W LEAGUE CITY PKWY
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6313
Mailing Address - Country:US
Mailing Address - Phone:281-813-2134
Mailing Address - Fax:281-332-7272
Practice Address - Street 1:UTMB HEALTH CLEAR LAKE CAMPUS HOSPITAL
Practice Address - Street 2:200 BLOSSOM STREET
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598
Practice Address - Country:US
Practice Address - Phone:832-632-6500
Practice Address - Fax:281-557-7284
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1069897363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner