MEDICARE: MRS. JACQUEL DEAN RN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	988104	TX

General Provider Information

NPI Number	:	1386397073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUEL DEAN RN

Provider Business Mailing Address
First Line	:	9706 CHIPSTEAD CT
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-6593
Country	:	US
Telephone Number	:	334-750-8289
Fax Number	:

Provider Business Practice Location Address
First Line	:	9706 CHIPSTEAD CT
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-6593
Country	:	US
Telephone Number	:	334-738-4269
Fax Number	:

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

Provider Enumeration Date	:	02/02/2022
Last Update Date	:	07/09/2025

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