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General NPI Number Information
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NPI Number | 1164786273
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Entity Type | Individual
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Provider Name | MICHELLE MARIE JASPER PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/03/2012
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 700 N PEARL ST STE N208
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City | DALLAS
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State | TX
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Zip | 75201-7430
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Country | US
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Telephone | 214-999-9355
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Fax | 214-999-9363
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Provider Business Mailing Address
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Address Line | 700 N PEARL ST STE N510
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City | DALLAS
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State | TX
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Zip | 75201-2863
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Country | US
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Telephone | 214-580-7277
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Fax | 214-999-9363
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA02010
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License Number State | TX
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