Individual
JENA SPOSTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA07345
TX
363AM0700X
Medical Physician Assistant
013586
NY
363AS0400X
Surgical Physician Assistant
MA054310
PA
363AS0400X
Surgical Physician Assistant
PA07345
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013586
LICENSE
NY
01
—
MA054310
STATE BOARD OF MEDICINE
PA
01
—
PA07345
PHYSICIAN ASSISTANCE LICENSE
TX
Enumeration date
10/05/2009
Last updated
10/30/2020
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