Individual
JENNIFER BRACKEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
13601 PRESTON RD, STE 1000W, DALLAS, TX 75240-4911
(972) 715-5000
Mailing address
PO BOX 650426, DALLAS, TX 75265-0426
(972) 715-5000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
N5584
TX
207L00000X
Anesthesiology Physician
OT011988
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213043701
—
TX
05
—
213043702
—
TX
05
—
213043703
—
TX
05
—
213043704
—
TX
05
—
213043705
—
TX
01
—
8CJ677
BCBS
—
01
—
P00857444
RAILROAD
TX
Enumeration date
04/23/2007
Last updated
10/03/2012
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