Provider Demographics
NPI:1174999395
Name:SMITH, JACQUELINE A
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:SMITH
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 1:3730 FM 1960 RD. W. STE.210
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068
Mailing Address - Country:US
Mailing Address - Phone:832-965-5777
Mailing Address - Fax:
Practice Address - Street 1:3730 FM 1960 RD W STE 210
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3508
Practice Address - Country:US
Practice Address - Phone:832-965-5777
Practice Address - Fax:713-765-0243
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX802249328251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health