MEDICARE: MRS. JUDY MARIE NIELL PA-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	363A00000X	Physician Assistant	PA02129	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01464137	OTHER	TX	RAIL ROAD MEDICARE
6	P01291627	OTHER	TX	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	75-0818167-044	OTHER	TX	TRICARE
3	8660NN	OTHER	TX	BCBS
4	75-2616977-022	OTHER	TX	TRICARE
5	75-0818167-015	OTHER	TX	TRICARE
7	75-2616977-028	OTHER	TX	TRICARE
8	8287ND	OTHER	TX	BCBS
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	75-0818167-048	OTHER	TX	TRICARE
13	75-1976930-005	OTHER	TX	TRICARE
14	75-2616977-002	OTHER	TX	TRICARE
15	8691NN	OTHER	TX	BCBS
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	75-2616977-001	OTHER	TX	TRICARE
18	8284ND	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1295865533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDY MARIE NIELL PA-C

Provider Business Mailing Address
First Line	:	PO BOX 846098
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-6098
Country	:	US
Telephone Number	:	903-324-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3203 S MAIN ST
Second Line	:
City	:	LINDALE
State	:	TX
Zip	:	75771-7727
Country	:	US
Telephone Number	:	903-882-0991
Fax Number	:

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	04/01/2016

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