MEDICARE: JEAN RENE YATES-HALBERT P.A.-C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA00602	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
11	P01434527	OTHER	TX	RAIL ROAD MEDICARE
14	P01635747	OTHER	TX	RAIL ROAD MEDICARE
16	P01479468	OTHER	TX	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	75-0818167-022	OTHER	TX	TRICARE
2	75-0818167-048	OTHER	TX	TRICARE
3	8983NM	OTHER	TX	BCBS
4	75-2616977-028	OTHER	TX	TRICARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	75-0818167-015	OTHER	TX	TRICARE
7	8071NR	OTHER	TX	BCBS
8	751976930005	OTHER	TX	TRICARE
9	8590NP	OTHER	TX	BCBS
10	8987NU	OTHER	TX	BCBS
12	75-2616977-002	OTHER	TX	TRICARE
13	75-2616977-007	OTHER	TX	TRICARE
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831197342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN RENE YATES-HALBERT P.A.-C.

Provider Business Mailing Address
First Line	:	PO BOX 873
Second Line	:
City	:	HALLSVILLE
State	:	TX
Zip	:	75650-0873
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 W MAIN STREET
Second Line	:	SUITE D
City	:	HALLSVILLE
State	:	TX
Zip	:	75650
Country	:	US
Telephone Number	:	903-668-7462
Fax Number	:	903-668-7400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	02/15/2022

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Directions to “ JEAN RENE YATES-HALBERT P.A.-C.” Practice Location

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