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NPI Code Detail

MEDICARE: CELYNNE JOELLE BEAUDOIN

MEDICARE: CELYNNE JOELLE BEAUDOIN
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
1390200000XStudent in an Organized Health Care Education/Training Program
2363A00000XPhysician AssistantPA15300TX

General Provider Information

NPI Number : 1962043562
Entity Type Code : Individual
Provider Name (Legal Business Name) : CELYNNE JOELLE BEAUDOIN
Provider Business Mailing Address
First Line : 7224 S ELWOOD AVE APT 29208
Second Line :
City : TULSA
State : OK
Zip : 74132-2462
Country : US
Telephone Number : 405-315-3087
Fax Number :
Provider Business Practice Location Address
First Line : 1135 N BISHOP AVE
Second Line :
City : DALLAS
State : TX
Zip : 75208-4114
Country : US
Telephone Number : 214-942-3100
Fax Number : 214-948-3697
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2019
Last Update Date : 03/01/2023

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Directions to “ CELYNNE JOELLE BEAUDOIN ” Practice Location

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