Celynne Joelle Beaudoin

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA15300 Issued in TX

Practice address

1135 N Bishop Ave
Dallas, TX 75208-4114

Phone

(214) 942-3100

Fax

(214) 948-3697

NPI assigned

Oct 4, 2019

Last updated

Mar 1, 2023By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Stella Mattina Primary Care Inc

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1396568713
  NPD (past)

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

{
    "created_epoch": "1570147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677628800000",
    "number": "1962043562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7224 S ELWOOD AVE APT 29208",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741322462",
            "telephone_number": "405-315-3087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 N BISHOP AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752084114",
            "telephone_number": "214-942-3100",
            "fax_number": "214-948-3697"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7224 S Elwood Ave Apt 29208",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741322462",
            "country_code": "US",
            "telephone_number": "405-315-3087",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BEAUDOIN",
        "first_name": "CELYNNE",
        "middle_name": "JOELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-04",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA15300",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janet Beattie, OT
• Regan Elizabeth Beaty
• Macey Lee Beauboeuf, CCC- SLP
• Cynthia Lais Beauchamp, MD
• Elizabeth Cruz Beauchamp, SLP
• Londyn Christopher Beaudoin
• Rebecca Beaupre
• Beauty Bar Aesthetics and Wellness
• Beauty Bar by Terri
• Andrea C Beavers, PA-C

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.