Individual
JACOB MAYBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AS-C
Contact information
Practice address
104 BLUE WATER DR, BRIDGEPORT, TX 76426-4336
(940) 683-8078
(940) 683-8078
Mailing address
104 BLUE WATER DR, BRIDGEPORT, TX 76426-4336
(940) 683-8078
(940) 683-8078
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
Primary
TC08-0326A
TX
Other
Enumeration date
06/25/2008
Last updated
06/25/2008
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