Jacqueline Eudora Deyounge-Gerideau, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA01588 Issued in TX

Practice address

2455 Robinson Rd
Suite 200
Grand Prairie, TX 75051-3852

Phone

(972) 522-5665

Fax

(972) 522-5605

NPI assigned

Aug 2, 2010

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Shepherds Gate Life Changing Center

  • Primary Care Clinic/Center
  • Grand Prairie, TX
  • NPI 1326004482
  NPD (past)

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

{
    "created_epoch": "1280707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280707200000",
    "number": "1609180645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2455 ROBINSON RD",
            "address_2": "SUITE 200",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750513852",
            "telephone_number": "972-522-5665",
            "fax_number": "972-522-5605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2455 ROBINSON RD",
            "address_2": "SUITE 200",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750513852",
            "telephone_number": "972-522-5665",
            "fax_number": "972-522-5605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEYOUNGE-GERIDEAU",
        "first_name": "JACQUELINE",
        "middle_name": "EUDORA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-02",
        "last_updated": "2010-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA01588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Devine Grace Hospice, Inc.
• Devine Holistic Home Health Care Inc
• Bill P Devine
• Devineidsolutions LLC
• Lashunda Dewitt
• DFW Better Care Physicians, PLLC
• DFW Family Clinic
• DFW Family Clinic
• DFW Practice Consultants, Inc.
• DFW Rehab and Diagnostics Inc.

• Physician Assistant in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2010; 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.