Jackie L Elson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA01090 Issued in TX

Practice address

902 W Randol Mill Rd
Suite 200
Arlington, TX 76012-2572

Phone

(817) 461-8327

Fax

(817) 275-2525

NPI assigned

Apr 11, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481155200000",
    "number": "1326001041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16980 DALLAS PKWY",
            "address_2": "SUITE 200",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752481908",
            "telephone_number": "817-461-8327",
            "fax_number": "817-275-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 W RANDOL MILL RD",
            "address_2": "SUITE 200",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760122572",
            "telephone_number": "817-461-8327",
            "fax_number": "817-275-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELSON",
        "first_name": "JACKIE",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-11",
        "last_updated": "2016-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA01090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "189128501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Ellis, MA, BCBA, LBA
• Sherrod Ellis
• Anthonetta Ellison
• Paige Talley Ellison, LPC
• Julie Paige Elmore, PMHNP-BC
• Clay Madison Elswick, M.D.
• Kelsey Jordan Elwood
• Misty Pearl Ely, EDD, LCSW, MHPS, PSS
• Ahmad Elzein
• Embrace Diabetes Footwear Solutions

• Physician Assistant in Arlington, TX
• Providers in Arlington, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.