Individual
JENEVA L SUMRALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
676 FM 517 RD W, DICKINSON, TX 77539-3904
(713) 482-4535
Mailing address
706 AVE G, MARBLE FALLS, TX 78654-5866
(830) 693-8234
(830) 693-9090
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
54327
CA
363A00000X
Physician Assistant
Primary
PA01264
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10013474
AMERIGROUP
TX
Enumeration date
11/18/2005
Last updated
12/19/2018
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