Individual
DR. M JEANINE TREVILLYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
501 WALNUT STREET, CORRECTIONAL MEDICAL SERVICES, TEXARKANA, AR 71854-0809
(870) 216-1256
Mailing address
POB 809, TEXARKANA, AR 71854-0809
(870) 216-1256
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
E-0884
AR
207Q00000X
Family Medicine Physician
E-0884
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129861001
—
AR
Enumeration date
12/14/2006
Last updated
11/16/2022
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