Provider Demographics
NPI:1932451747
Name:ARUNTHAMAKUN, JERICA (PA)
Entity Type:Individual
Prefix:
First Name:JERICA
Middle Name:
Last Name:ARUNTHAMAKUN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:PIGEON FORGE
Mailing Address - State:TN
Mailing Address - Zip Code:37863-3310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1331 W GRAND PKWY N
Practice Address - Street 2:SUITE #203
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2710
Practice Address - Country:US
Practice Address - Phone:281-392-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2014-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
TN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant