Individual provider · NPI-1

Jacqueline Eudora Deyounge-Gerideau, PA-C

Physician Assistant · Grand Prairie, TX

NPI number1609180645
StatusActive
Last updated in NPPESAug 2, 2010

Details

NPI
1609180645
Entity type
Individual (NPI-1)
Name
Jacqueline Eudora Deyounge-Gerideau
Credential
PA-C
Sex
Female
Sole proprietor
No
Enumeration date
Aug 2, 2010
Last updated
Aug 2, 2010

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363A00000X Physician AssistantPA01588TXYes

Practice location

2455 Robinson Rd
Suite 200
Grand Prairie, TX 75051-3852

Phone 972-522-5665 · Fax 972-522-5605

Mailing address

2455 Robinson Rd
Suite 200
Grand Prairie, TX 75051-3852

Phone 972-522-5665 · Fax 972-522-5605

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