Organization
JACQUELENE MITCHELL ADIELE, MD, PA
Active
Organization
JACQUELENE MITCHELL ADIELE, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACQUELENE MITCHELL ADIELE MD (OWNER)
(254) 371-1172
Entity
Organization
Contact information
Practice address
3816 S CLEAR CREEK RD, SUITE A, KILLEEN, TX 76549-4400
(254) 200-2748
(254) 200-2757
Mailing address
PO BOX 938, KILLEEN, TX 76540-0938
(254) 634-6999
(254) 200-4099
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
J2678
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
034049902
MEDICAID (INDIVIDUAL)
TX
01
—
1306106687
NPI (GROUP)
—
01
—
1609896497
NPI (INDIVIDUAL)
—
01
—
306297801
MEDICAID (GROUP)
TX
01
—
TXB158052
MEDICARE (GROUP)
TX
01
—
TXB158053
MEDICARE (INDIVIDUAL)
TX
Enumeration date
05/21/2012
Last updated
12/17/2013
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