Preston, Jackie Lynn
Preston, Jackie Lynn is an individual health care provider with primary practice located at 120 E Harris Ave , San Angelo TX 76903-5904. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Preston, Jackie Lynn can be contacted via phone (325) 653-6741.Contact Information
Primary practice address
120 E Harris Ave
San Angelo TX 76903-5904
Phone: (325) 653-6741
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | H4758 | Texas |
Profile Details
| NPI number | 1366445611 |
|---|---|
| LBN Legal business name | Preston, Jackie Lynn |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 31st, 2005 |
| Last updated | Dec 19th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1366445611 | NPPES |
| Texas | MEDICAID | 133739610 | |
| Texas | Other | 8R7522 |
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