Provider Demographics
NPI:1447959929
Name:ORNELAS-STANTON, JYNELLE NICOLE (MT, MMP)
Entity type:Individual
Prefix:
First Name:JYNELLE
Middle Name:NICOLE
Last Name:ORNELAS-STANTON
Suffix:
Gender:F
Credentials:MT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 N LOWER BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78401-2321
Mailing Address - Country:US
Mailing Address - Phone:136-173-7781
Mailing Address - Fax:
Practice Address - Street 1:602 N LOWER BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-2321
Practice Address - Country:US
Practice Address - Phone:136-173-7781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT130521225700000X
TXMT116053225700000X
TXMT109678225700000X
TXMT136583225700000X
TXMT129454225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMT129454OtherMASSAGE THERAPIST
TXMT130521OtherMASSAGE THERAPIST
TXMT136583OtherMASSAGE THERAPIST
TXMT109678OtherMASSAGE THEARPIST