Provider Demographics
NPI:1255300430
Name:ARNOLD, JILL MOORE (PAC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MOORE
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MOORE
Other - Last Name:SAAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4501 MEDICAL CENTER DR
Mailing Address - Street 2:STE 200
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1651
Mailing Address - Country:US
Mailing Address - Phone:972-547-0352
Mailing Address - Fax:972-542-3528
Practice Address - Street 1:4501 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1651
Practice Address - Country:US
Practice Address - Phone:972-547-0352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02594363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190459102Medicaid
TX8L1470Medicare PIN
TX190459102Medicaid
TX8J4278Medicare PIN
P45983Medicare UPIN