Jacqueline G. Abraham
Individual provider Active NPI Physician Assistant · Rowlett, TX
NPI 1194292219 · NPPES record last updated Aug 10, 2020
Key facts
- NPI
- 1194292219
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 9517 Fairway Vista Dr
Rowlett, TX 75089 - Phone
- (214) 556-7169
- NPI assigned
- Oct 26, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210315001722 | TX | Practitioner - Physician Assistant | 2365858495 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lonestar Provider Network | Past | Accepting new patients |
Interoperability endpoints
- jacqueline.abraham@hca7.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
9517 Fairway Vista Dr
Rowlett, TX 75089
Mailing address
9517 Fairway Vista Dr
Rowlett, TX 75089
Phone (214) 556-7169
Other providers in Rowlett, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.