Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 16097 | TX |
Y | 213EG0000X | General Practice | 16097 | TX |
NPI | 1003818170 |
---|---|
Provider Name | Jacquelyn Ann Stanfield |
First Address | Flower Mound, TX 75028-2900 |
Second Address | Flower Mound, TX 75028-2900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2005 |
Last Update Date | 08/07/2007 |