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General NPI Number Information
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NPI Number | 1912626227
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Entity Type | Individual
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Provider Name | JACQUELYNN T ANDERSON PA
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Gender | Female
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 904 FORD ST
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City | LLANO
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State | TX
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Zip | 78643-2345
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Country | US
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Telephone | 830-953-1700
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Fax | 830-953-1717
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Provider Business Mailing Address
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Address Line | 3600 N EDWARDS ST APT 2216
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City | MIDLAND
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State | TX
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Zip | 79705-5229
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Country | US
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Telephone | 254-466-9859
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Fax |
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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 | PA18346
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License Number State | TX
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