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Individual
STEPHANIE JACKS
Active
Individual
STEPHANIE JACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
R4401
TX
208000000X
Pediatrics Physician
Primary
R4401
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06536832
—
MS
01
—
P01500386
RAILROAD MEDICARE PTAN
MS
Enumeration date
05/27/2009
Last updated
07/08/2026
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