Knieeka Shanell Jake-Pacheco, DMD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

29374 Issued in TX

Practice address

3111 S Texas Ave
Bryan, TX 77802

Phone

(979) 446-0270

Fax

(979) 775-7641

NPI assigned

Aug 28, 2009

Last updated

Aug 28, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Ms. Knieeka Shanell Jake Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Carestl Health

  • Federally Qualified Health Center (FQHC)
  • Overland, MO
  • NPI 1275363137
  NPD (past)
• Carestl Health

  • Federally Qualified Health Center (FQHC)
  • Jennings, MO
  • NPI 1912440876
  NPD (past)
• Tibbitts Temecula Dental Group

  dba Dr Andrew Tibbitts DDS

  • Dental Clinic/Center
  • Temecula, CA
  • NPI 1477029502
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535414400000",
    "number": "1063645745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3111 S TEXAS AVE",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778023124",
            "telephone_number": "979-446-0270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 S TEXAS AVE",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "77802",
            "telephone_number": "979-446-0270",
            "fax_number": "979-775-7641"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "32909 Temecula Pkwy",
            "address_2": "#102",
            "address_purpose": "LOCATION",
            "city": "Temecula",
            "state": "CA",
            "postal_code": "925926918",
            "country_code": "US",
            "telephone_number": "951-972-8080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAKE-PACHECO",
        "first_name": "KNIEEKA",
        "middle_name": "SHANELL",
        "name_prefix": "Mrs.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-28",
        "last_updated": "2018-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "62350",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "200916780",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TX",
            "license": "29374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KNIEEKA",
            "last_name": "JAKE",
            "middle_name": "SHANELL",
            "prefix": "MS.",
            "credential": "DMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• J. T. L. McNew, M.D., Faafp
• Jamonica Jackson
• Lakendra Jackson
• Lyric Leanna Jackson
• Vinaya Kumar Jagadeeshan, MD
• Andrea Grace Jakubec, PT, DPT
• James M Kirby and Joseph J Fedorchik (Cardiovascular Surgery of Brazos Valley)
• James V Stonecipher MD PA (Texas Pain & Spine Consultants)
• Hillary James, M.ED., CCC-SLP
• Denise Ellen Janda, PTA

• Orthodontics and Dentofacial Orthopedics Dentistry in Bryan, TX
• Providers in Bryan, TX by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.