Individual
JODY D. MACKLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
1935 MEDICAL DISTRICT DRIVE, DALLAS, TX 75235
(214) 456-8000
Mailing address
1935 MEDICAL DISTRICT DRIVE, DALLAS, TX 75235
(214) 456-8000
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
671189
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
192349204
—
TX
05
—
192349205
—
TX
01
—
75-2616977-027
TRICARE
TX
01
—
752616977118
TRICARE
TX
01
—
855N92
BCBS
TX
01
—
886N35
BCBS
TX
Enumeration date
10/15/2007
Last updated
09/26/2012
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