Provider Demographics
NPI:1891266144
Name:PICKERING WOLSKI, JEANELLE DENISE (LSA)
Entity Type:Individual
Prefix:
First Name:JEANELLE
Middle Name:DENISE
Last Name:PICKERING WOLSKI
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 SAND CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7664
Mailing Address - Country:US
Mailing Address - Phone:512-716-9664
Mailing Address - Fax:
Practice Address - Street 1:4700 SETON CENTER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-6215
Practice Address - Country:US
Practice Address - Phone:512-439-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00767363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty