Provider Demographics
NPI:1639361397
Name:BELYEA, JERI JO (PAC)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:JO
Last Name:BELYEA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8517 FM 1826 BLDG 2
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-1473
Mailing Address - Country:US
Mailing Address - Phone:512-416-0044
Mailing Address - Fax:512-462-9765
Practice Address - Street 1:8517 FM 1826 BLDG 2
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-1473
Practice Address - Country:US
Practice Address - Phone:512-416-0044
Practice Address - Fax:512-462-9765
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02951363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J9214Medicare PIN