Individual
MRS. JACQUELINE MOUTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
21216 NORTHWEST FWY, SUITE 620, CYPRESS, TX 77429-1439
(281) 469-7704
(281) 469-4066
Mailing address
21216 NORTHWEST FWY, SUITE 620, CYPRESS, TX 77429-1439
(281) 469-7704
(281) 469-4066
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA05855
TX
363AM0700X
Medical Physician Assistant
PA00854
OR
Other
Enumeration date
05/20/2008
Last updated
03/28/2012
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