Provider Demographics
NPI:1427165745
Name:SEABORN, JOWELL ORTEGA (PA-C)
Entity type:Individual
Prefix:
First Name:JOWELL
Middle Name:ORTEGA
Last Name:SEABORN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JOWELL
Other - Middle Name:MANDE
Other - Last Name:ORTEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14201 DALLAS PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-2916
Mailing Address - Country:US
Mailing Address - Phone:469-893-6580
Mailing Address - Fax:
Practice Address - Street 1:13521 OLD HIGHWAY 280 STE 225
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-1407
Practice Address - Country:US
Practice Address - Phone:205-773-1130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0004994363AM0700X
AL1774363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP85603Medicare UPIN
HIVAD000Medicare UPIN
CA0PA165340Medicare PIN