Provider Demographics
NPI:1275165862
Name:MEADORS, JACINDA
Entity Type:Individual
Prefix:
First Name:JACINDA
Middle Name:
Last Name:MEADORS
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 1:150 BISCAYNE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1361
Mailing Address - Country:US
Mailing Address - Phone:214-215-9985
Mailing Address - Fax:
Practice Address - Street 1:1059 MCDONALD ST
Practice Address - Street 2:
Practice Address - City:HAYNESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71038-5235
Practice Address - Country:US
Practice Address - Phone:214-215-9985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care