Provider Demographics
NPI:1932400751
Name:DECKER, JACQUELINE S (PA-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:S
Last Name:DECKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:S
Other - Last Name:KARPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8440 WALNUT HILL LN STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3816
Mailing Address - Country:US
Mailing Address - Phone:214-363-5660
Mailing Address - Fax:214-373-7030
Practice Address - Street 1:8440 WALNUT HILL LN STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3816
Practice Address - Country:US
Practice Address - Phone:214-363-5660
Practice Address - Fax:214-373-7030
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07066363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB123121Medicare PIN
TXTXB120838Medicare PIN
TXTXB123124Medicare PIN
TXTXB120836Medicare PIN
TXTXB123125Medicare PIN
TXTXB120839Medicare PIN