Jeanne M Russell, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA00473 Issued in TX

Practice address

17226 Mercury Dr Ste 100
Houston, TX 77058-2793

Phone

(281) 975-0600

Fax

(281) 975-0601

NPI assigned

Mar 9, 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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Regional Clinics of Longview

  • Internal Medicine Physician
  • Longview, TX
  • NPI 1407047863
  NPD (past)

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1427026079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17226 MERCURY DR",
            "address_2": "SUITE 100",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770582792",
            "telephone_number": "281-975-0600",
            "fax_number": "281-975-0601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17226 MERCURY DR STE 100",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770582793",
            "telephone_number": "281-975-0600",
            "fax_number": "281-975-0601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "707 Hollybrook Dr",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756052410",
            "country_code": "US",
            "telephone_number": "903-757-6042",
            "fax_number": "903-232-8298",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "JEANNE",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-09",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA00473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207783602",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Frances Russell, LPC, LMFT, RPT-S
• Gary Russell
• Heidi Russell, MD
• Ioulia Russell
• Jasmine S Russell
• Jonathan R. Russell, M.D.
• Kionte Russell, DPT
• Matasha L Russell, M.D.
• Melissa Lee Russell, ATC, LAT
• Melodi Russell, LPC, NCC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.