Provider Demographics
NPI:1124188636
Name:PRESSON, JACQUELINE MILLER
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:MILLER
Last Name:PRESSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-0355
Mailing Address - Fax:
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-645-0335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX581161367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
1447220850OtherGRP NPI NUMBER
TX002725201Medicaid
TX1548540594OtherGROUP NPI
TX2256620OtherUHC PIN
TX137345809Medicaid
TX10024586OtherAMERIGROUP PIN
S71338Medicare UPIN
1447220850OtherGRP NPI NUMBER
TX00N47FMedicare PIN
TX137345809Medicaid