Provider Demographics
NPI:1306373642
Name:BOBADILLA, JACKELINE (MSPAS, PA-C)
Entity type:Individual
Prefix:MRS
First Name:JACKELINE
Middle Name:
Last Name:BOBADILLA
Suffix:
Gender:F
Credentials:MSPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 PINELAND DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5300
Mailing Address - Country:US
Mailing Address - Phone:214-221-0855
Mailing Address - Fax:
Practice Address - Street 1:5750 PINELAND DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5300
Practice Address - Country:US
Practice Address - Phone:214-221-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA18520208000000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208000000XAllopathic & Osteopathic PhysiciansPediatrics