Provider Demographics
NPI:1992013239
Name:KILGARD, JEANNETTE LARUE (PA-C)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:LARUE
Last Name:KILGARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17101 PRESTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1331
Mailing Address - Country:US
Mailing Address - Phone:469-828-4342
Mailing Address - Fax:972-239-1597
Practice Address - Street 1:17101 PRESTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1331
Practice Address - Country:US
Practice Address - Phone:469-828-4342
Practice Address - Fax:972-239-1597
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02354363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical