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  7. NPI Record 1700374493

JENNIFER IMASUEN PA-C
Complete NPI Record 1700374493
Physician Assistant in Dallas, TX

NPI Status: Active since April 27, 2018

Contact Information

1441 N BECKLEY AVE
DALLAS, TX
ZIP 75203
Phone: (214) 947-2385
Fax: (214) 947-2390

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Credential Text
  6. Provider First Line Business Mailing Address
  7. Provider Business Mailing Address City Name
  8. Provider Business Mailing Address State Name
  9. Provider Business Mailing Address Postal Code
  10. Provider Business Mailing Address Country Code If outside U S
  11. Provider Business Mailing Address Telephone Number
  12. Provider Business Mailing Address Fax Number
  13. Provider First Line Business Practice Location Address
  14. Provider Business Practice Location Address City Name
  15. Provider Business Practice Location Address State Name
  16. Provider Business Practice Location Address Postal Code
  17. Provider Business Practice Location Address Country Code If outside U S
  18. Provider Business Practice Location Address Telephone Number
  19. Provider Business Practice Location Address Fax Number
  20. Provider Enumeration Date
  21. Last Update Date
  22. Provider Gender Code
  23. Healthcare Provider Taxonomy Code 1
  24. Provider License Number 1
  25. Provider License Number State Code 1
  26. Healthcare Provider Primary Taxonomy Switch 1
  27. Healthcare Provider Taxonomy Code 2
  28. Provider License Number 2
  29. Provider License Number State Code 2
  30. Healthcare Provider Primary Taxonomy Switch 2
  31. Is Sole Proprietor
  32. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1700374493. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1700374493
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The country code in the location address of the provider being identified.
Provider First Name: JENNIFER
The telephone number associated with the location address of the provider being identified.
Provider Credential Text: PA-C
The date the provider was assigned a unique identifier (assigned an NPI).
Provider First Line Business Mailing Address: 1441 N BECKLEY AVE
The date that a record was last updated or changed.
Provider Business Mailing Address City Name: DALLAS
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Provider Business Mailing Address State Name: TX
The first name of the authorized official.
Provider Business Mailing Address Postal Code: 752031201
The title or position of the authorized official.
Provider Business Mailing Address Country Code If outside U S : US
The 10-position telephone number of the authorized official.
Provider Business Mailing Address Telephone Number: 2149472385
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider Business Mailing Address Fax Number: 2149472390
Provider First Line Business Practice Location Address: 1441 N BECKLEY AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: DALLAS
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: TX
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 752031201
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 2149472385
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 2149472390
The first name of the provider, if the provider is an individual.
Provider Enumeration Date: 4/27/2018
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Last Update Date: 10/18/2021
The city name in the mailing address of the provider being identified.
Provider Gender Code: F
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Healthcare Provider Taxonomy Code 1: 363A00000X
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider License Number 1: 021995-1
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: NY
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 363A00000X
The city name in the location address of the provider being identified.
Provider License Number 2: PA13558
The State code in the location of the provider being identified.
Provider License Number State Code 2: TX
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Healthcare Provider Primary Taxonomy Switch 2: Y
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
NPI Certification Date: 10/18/2021