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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