Individual
JACQUELINE EMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4770 REGENT BLVD, IRVING, TX 75063-2445
(972) 934-4300
Mailing address
14275 MIDWAY RD, STE 400, ADDISON, TX 75001-3676
(214) 590-8058
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
M9264
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BP1-0017679
INSTITUTIONAL PERMIT
—
Enumeration date
06/09/2007
Last updated
07/21/2022
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