Provider Demographics
NPI:1679059950
Name:JAISON, RACHEL
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:JAISON
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 1:9900 N CENTRAL EXPY STE 225
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0918
Mailing Address - Country:US
Mailing Address - Phone:469-646-8880
Mailing Address - Fax:469-646-8884
Practice Address - Street 1:8210 WALNUT HILL LN STE 306
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4419
Practice Address - Country:US
Practice Address - Phone:469-646-8880
Practice Address - Fax:469-646-8884
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily