Individual
JEANNETTE R RACKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1717 MAIN ST, STE 5200, DALLAS, TX 75201-4612
(214) 712-2775
Mailing address
5551 CLAY CT, GRAND PRAIRIE, TX 75052-0705
(254) 702-7665
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA03203
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181488102
—
TX
01
—
8N9119
BLUE SHIELD
TX
Enumeration date
04/05/2006
Last updated
12/26/2012
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