Individual
JACLYN STACY FAULK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1100 WILFORD HALL LOOP, JBSA LACKLAND, TX 78236-5638
(210) 292-4277
Mailing address
1100 WILFORD HALL LOOP, JBSA LACKLAND, TX 78236-5638
(210) 292-4277
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
26918
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/15/2017
Last updated
07/16/2024
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