1669997375 NPI number — JEGEDE & ASSOCIATES, PLLC

Table of content: (NPI 1669997375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669997375 NPI number — JEGEDE & ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEGEDE & ASSOCIATES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669997375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 SHANNON OXMOOR RD # 67
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHANNON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35142-2000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-212-4243
Provider Business Mailing Address Fax Number:
972-284-1088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2311 MUSTANG DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAPEVINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76051-1010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-600-8892
Provider Business Practice Location Address Fax Number:
682-503-6106
Provider Enumeration Date:
08/03/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JEGEDE
Authorized Official First Name:
ADEJOKE
Authorized Official Middle Name:
Authorized Official Title or Position:
NEUROPSYCHOLOGIST
Authorized Official Telephone Number:
817-600-8892

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 34277 , 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)