Individual
JACQUELENE MITCHELL ADIELE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
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
05
—
034049902
—
TX
01
—
1609896497
INDIVIDUAL NPI
—
01
—
J2678
TX MEDICAL BOARD LICENSE
TX
01
—
TXB158053
MEDICARE
TX
Enumeration date
07/21/2006
Last updated
12/17/2013
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