Provider Demographics
NPI:1962375295
Name:DE JONG, MAKAYLA RAE
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:RAE
Last Name:DE JONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 ALABAMA ST APT 5107
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-2415
Mailing Address - Country:US
Mailing Address - Phone:915-544-9600
Mailing Address - Fax:
Practice Address - Street 1:1411 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5617
Practice Address - Country:US
Practice Address - Phone:915-544-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife