Provider Demographics
NPI:1427311679
Name:JEBAKUMAR, ADLENE JENITA (MD,)
Entity type:Individual
Prefix:
First Name:ADLENE JENITA
Middle Name:
Last Name:JEBAKUMAR
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 HICKORY ST STE 200F
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2305
Mailing Address - Country:US
Mailing Address - Phone:325-670-4590
Mailing Address - Fax:325-670-4587
Practice Address - Street 1:1850 HICKORY ST STE 200F
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2305
Practice Address - Country:US
Practice Address - Phone:325-670-4590
Practice Address - Fax:325-670-4587
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN59440207R00000X
390200000X
TXS0910207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program