Provider Demographics
NPI:1578804845
Name:BROWN, JACQUELINE DENISE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:DENISE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:TRAINEE HEALTH CLINIC
Mailing Address - Street 2:559TH THLS/SGTT REID CLINIC / BLDG 7002
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78236
Mailing Address - Country:US
Mailing Address - Phone:210-292-1362
Mailing Address - Fax:
Practice Address - Street 1:TRAINEE HEALTH CLINIC
Practice Address - Street 2:559TH THLS/SGTT REID CLINIC / BLDG 7002
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78236
Practice Address - Country:US
Practice Address - Phone:210-292-1362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1111478OtherNCCPA NUMBER