Individual
MRS. JACQUELINE DENISE ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SURGICAL ASSISTANT
Contact information
Practice address
640 ACR 3593, PALESTINE, TX 75803
(903) 729-1518
(903) 389-4237
Mailing address
640 ACR 3593, PALESTINE, TX 75803
(903) 729-1518
(903) 389-4237
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
SA00028
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0067JR
BCBS ID
TX
Enumeration date
11/30/2006
Last updated
07/08/2007
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