Provider Demographics
NPI:1831197342
Name:YATES-HALBERT, JEAN RENE (PA-C)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:RENE
Last Name:YATES-HALBERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RENE
Other - Middle Name:
Other - Last Name:HALBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 873
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650-0873
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 W MAIN STREET
Practice Address - Street 2:SUITE D
Practice Address - City:HALLSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75650
Practice Address - Country:US
Practice Address - Phone:903-668-7462
Practice Address - Fax:903-668-7400
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00602363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-0818167-022OtherTRICARE
TX75-0818167-048OtherTRICARE
TX8983NMOtherBCBS
TX75-2616977-028OtherTRICARE
TX334524103Medicaid
TX75-0818167-015OtherTRICARE
TX8071NROtherBCBS
TX751976930005OtherTRICARE
TX8590NPOtherBCBS
TX8987NUOtherBCBS
TXP01434527OtherRAIL ROAD MEDICARE
TX75-2616977-002OtherTRICARE
TX75-2616977-007OtherTRICARE
TXP01635747OtherRAIL ROAD MEDICARE
TX334524105Medicaid
TXP01479468OtherRAIL ROAD MEDICARE
TX334524102Medicaid
TX334524103Medicaid
TX386945YMAFMedicare PIN
TX75-0818167-022OtherTRICARE
TX406914YNSXMedicare PIN
TXR98569Medicare UPIN