Provider Demographics
NPI:1164786273
Name:JASPER, MICHELLE MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:JASPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N PEARL ST STE N510
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-2863
Mailing Address - Country:US
Mailing Address - Phone:214-580-7277
Mailing Address - Fax:214-999-9363
Practice Address - Street 1:700 N PEARL ST STE N208
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-7430
Practice Address - Country:US
Practice Address - Phone:214-999-9355
Practice Address - Fax:214-999-9363
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02010363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX329465YXEWMedicare PIN