1730164617 NPI number — JACQUELYN ANDREA COATES PHYSICIAN ASSISTANT

Table of content: JACQUELYN ANDREA COATES PHYSICIAN ASSISTANT (NPI 1730164617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730164617 NPI number — JACQUELYN ANDREA COATES PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COATES
Provider First Name:
JACQUELYN
Provider Middle Name:
ANDREA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CANTU
Provider Other First Name:
JACQUELYN
Provider Other Middle Name:
ANDREA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICIAN ASSISTANT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730164617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 TEXAN TRAIL
Provider Second Line Business Mailing Address:
STE. 300
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78411-2549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-854-0811
Provider Business Mailing Address Fax Number:
361-806-5040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 TEXAN TRAIL
Provider Second Line Business Practice Location Address:
STE. 300
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78411-2549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-854-0811
Provider Business Practice Location Address Fax Number:
361-806-5040
Provider Enumeration Date:
12/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  PA04397 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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