Doctor Name: | JACLYN JO ANDREW |
NPI Number: | 1730306572 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 111348 |
Business Practice Address: | 4600 Taft Blvd Wichita Falls, TX - 763084935 |
Business Phone Number: | 9406911710 |
Business Fax Number: | 9406912193 |
Mailing Address: | 5238 Sunnybrook Ln, WICHITA FALLS |
State: | TX |
Postal Code: | 763103497 |
Phone Number: | 9406422193 |
Fax Number: | |
NPI Enumeration Date: | 04/20/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 111348 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |